Revenue Cycle Credentialing & Denials Pro

Critical Care Pulmonary and Sleep Associates; Lakewood (CO); On-site; USD 30,000 - 47,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision benefits

Life and AD&D benefits

PTO and holidays

401k with company contribution

Job summary

Critical Care, Pulmonary and Sleep Associates seeks a Credentialing and Denials Specialist to credential providers, enroll and privilege them, and manage denials to support timely reimbursement and uninterrupted patient care.

The role requires coordinating with internal teams and payers, maintaining compliant credentialing records, and improving revenue cycle performance while upholding CCPSA's collaborative culture.

Qualifications

• Minimum of two (2) years of experience in provider credentialing, payer enrollment, medical billing, denial management, or revenue cycle operations.
• Demonstrated experience researching, appealing, and resolving insurance claim denials.
• Working knowledge of medical terminology, provider taxonomy, commercial and government payer guidelines, credentialing requirements, and healthcare reimbursement methodologies.
• Knowledge of hospital credentialing and privileging processes preferred.
• Excellent analytical, organizational, problem-solving, and critical thinking skills.

Responsibilities

• Credentialing, enrollment, and privileging across commercial and government payers, hospitals, and other healthcare organizations to support uninterrupted operations.
• Review denial work queues and investigate denied claims for accurate and timely resolution.
• Research and appeal insurance claim denials through review of coding, records, and payer contracts.
• Maintain knowledge of payer websites, guidelines, and appeal processes for various payers.
• Collaborate with providers, payers, coding, billing, and other internal teams to resolve reimbursement issues and support revenue cycle performance.

Skills

Credentialing

Payer enrollment

Denials management

Revenue cycle

Communication skills

Analytical thinking

Time management

Customer service

Independent worker

Education

High School Diploma or GED

Tools

EPIC Resolute Professional Billing

CAQH

Payer portals

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Critical Care, Pulmonary and Sleep Associates seeks a Credentialing and Denials Specialist to credential providers, enroll and privilege them, and manage denials to support timely reimbursement and uninterrupted patient care.

The role requires coordinating with internal teams and payers, maintaining compliant credentialing records, and improving revenue cycle performance while upholding CCPSA's collaborative culture.