Payer Credentialing Specialist

Our Billing Co; Buffalo (NY); On-site; USD 33,000 - 41,000; Full time

Benefits offered by this job

Competitive benefits package

Fully remote

Job summary

Our Billing Co., a fully remote provider, seeks a Payer Credentialing Specialist to file with insurers and coordinate with physicians and practice leaders. You will oversee credentialing and re-credentialing for multiple payers, ensuring accurate, timely submissions and regulatory compliance.

The ideal candidate has two+ years in physician credentialing, strong attention to detail, and proficiency with credentialing databases and MS Office. A competitive benefits package is offered.

Qualifications

• Two years of physician credentialing experience required.
• HS diploma or GED required; associates degree preferred.
• Strong attention to detail and problem-solving abilities.

Responsibilities

• Coordinate with physicians, practice managers, and the credentialing vendor.
• Verify and maintain payer credentials and licensure.
• Oversee all-payer credentialing paperwork and re-credentialing.
• Maintain a practitioner database with training, licensure, and experience data.
• Ensure HIPAA, Joint Commission, NCQA and CMS compliance across processes.

Skills

Credentialing experience

MS Office Suite

Detail-oriented

Problem-solving

Time management

Effective communication

Education

High School Diploma or GED

Associates of Arts (AA) preferred

Tools

Credentialing database software

Job description

Our Billing Co. is seeking a PayerCredentialing Specialistto join our team!

The PayerCredentialing Specialist is an important member of Our Billing Team. This individual is responsible for preparing the correspondence, gathering credentialing paperwork, andworking with thecredentialing vendor to file with the insurance. The Credentialing Specialist will coordinate with physicians, practice managers, practice directors, and executive-level leaders. Ultimately, the following functions serve to ensure no lapses of credentialing and to promote coordination with our vendor and Contracting teams to ensure coverage and participation with insurance for our patients and community.

Essential Functions:

• Works with other department managers and staff—including physicians, managed care, contracting, and other professional staff—to acquire necessary materials and information for provider certification and licensure to promote organization-wide compliance with credentialing policies and procedures.
• Provides oversight of verification and payer credentialing of health care professions and credentials are in compliance with state and federal standards.
• Oversees process and organization of all-payer credentialing and re-credentialing paperwork with participating insurance companies.
• Maintains a database of practitioner’s training, education, licensing, and experience information.
• Key liaison with Medical Staff team, outside vendor, and IT for HIS system updates.
• Assists in filling out and reviewing applications with practitioners and other applicable staff Performs ongoing provider database maintenance for accuracy and completeness.
• Performs ongoing provider database maintenance for accuracy and completeness.
• Remains compliant with and knowledgeable of rules and regulations set forth by the Health Information Portability and Accountability Act (HIPAA), Joint Commission standards, the HCQIA, the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), as well as state regulations—and relays this information to the necessary parties to ensure ongoing compliance organization-wide.

Minimum/Preferred Qualifications:

• HS - High School Diploma or GED is required.
• AA - Associates of Arts is preferred.
• Minimum of two years of experience in physician credentialing is required.

Knowledge, Skills and Abilities:

• Exemplary problem-solving and conflict-resolution skills.
• Detail-oriented.
• Skilled in synthesizing a wealth of information.
• Exhibits excellent time management and prioritization abilities.
• Communicates effectively both one-on-one and in a group setting.
• Capable of following and providing detailed instructions both orally and through written communication.
• Experience with credentialing database management software preferred.
• Extensive experience working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access, Project).

This job will be fully remote.

Our Billing Co. offers a competitive benefits package!

Pay Range: $24.00 - $30.00

Individual annual salaries/hourly rates will be set within job's compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and expertise of the individual and internal equity considerations.