Payer Credentialing Specialist

Our Billing Co. is seeking a Payer Credentialing Specialist to join our remote team.

About the role

This individual is responsible for preparing correspondence, gathering credentialing paperwork, and working with the credentialing vendor to file with insurance companies. The Credentialing Specialist coordinates with physicians, practice managers, practice directors, and executive-level leaders to ensure no lapses in credentialing and to promote coordination with our vendor and Contracting teams for insurance coverage and participation.

Responsibilities

• Works with department managers and staff—including physicians, managed care, contracting, and other professional staff—to acquire necessary materials and information for provider certification and licensure, ensuring organization-wide compliance with credentialing policies and procedures.
• Provides oversight of verification and payer credentialing of healthcare professionals to ensure credentials comply with state and federal standards.
• Oversees the process and organization of all-payer credentialing and re-credentialing paperwork with participating insurance companies.
• Maintains a database of practitioners’ training, education, licensing, and experience information.
• Serves as a key liaison with the 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.
• Remains compliant with and knowledgeable of rules and regulations set forth by HIPAA, Joint Commission standards, HCQIA, NCQA, CMS, and state regulations—and relays this information to necessary parties to ensure ongoing compliance.

Requirements

• High School Diploma or GED (required).
• Associate of Arts degree (preferred).
• Minimum of two years of experience in physician credentialing (required).

Skills

• Exemplary problem-solving and conflict-resolution skills.
• Detail-oriented with strong organizational abilities.
• Skilled in synthesizing a wealth of information.
• Excellent time management and prioritization abilities.
• Effective communication both one-on-one and in group settings.
• Capable of following and providing detailed instructions orally and in writing.
• Experience with credentialing database management software (preferred).
• Extensive experience with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access, Project).

Benefits

Our Billing Co. offers a competitive benefits package.

Pay

Pay Range: $24.00 - $30.00 per hour. Individual salaries will be set within this range based on factors including market data, education, experience, qualifications, and internal equity considerations.