Revenue Cycle Credentialing Specialist

About the role

The Revenue Cycle Contract Credentialing Specialist facilitates contract implementation by ensuring alignment with corporate goals, contracts, and regulations. This role is field-based and involves expanding payor profiles, processing applications, updating NPI records, and managing re-credentialing.

Responsibilities

• Prepare and maintain credentialing files and reports for all payors and government entities.
• Expand government and commercial payor profiles to include all lines of business units due to mergers and acquisitions.
• Process and file applications with third-party payors according to each payor's individual requirements.
• Address enrollment deficiencies and payor issues regarding commercial and government entities.
• Assist with electronic funds transfer (EFT) and electronic data interchange (EDI) enrollment, tracking, and filing.
• Maintain historical data and files.
• Interface with multiple departments to provide updates and stay informed of current initiatives affecting credentialing and enrollment.
• Monitor incoming emails for various support and contract management tasks.

Requirements

• Associates degree in healthcare administration, public health, business administration, or related field; or 2 years of relevant experience in lieu of an Associates degree.
• 1+ years of contracting experience within the healthcare industry.
• Demonstrated knowledge of public and private Managed Care payers and reimbursement processes.
• Demonstrated understanding of market-related issues, contract development, negotiation, and pull through, as well as the legal and regulatory implications associated with private and government payer contracting.
• Basic knowledge of Microsoft Office; including Word, Excel, Access, Outlook, and PowerPoint.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.

Qualifications

• Authorization to work in the United States without sponsorship.

Skills

• Effective communication skills, both written and oral, across internal and external stakeholders.
• Promote an open, collaborative environment built on trust to foster positive teamwork.
• Apply strong attention to detail, organizational, and analytical skills.
• Ability to prioritize and manage several projects at once and drive to results with a high emphasis on quality.
• Ability to influence without authority.
• Ability to identify and implement enhancement opportunities.
• Ability to integrate and apply feedback in a professional manner.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.

Benefits

Exact Sciences offers an employee experience that includes paid time off, paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage. The annual base salary shown is a national range for this position on a full-time basis and may differ by hiring location. In addition, this position is bonus eligible.