Credentialing Specialist
Caravel Autism Health•Green Bay, WI
•Remote
About The Position
The Credentialing Specialist is responsible for all credentialing activities and initial analysis of new contracts. This role involves managing credentialing processes, working with payors and providers, reviewing contracts, and ensuring departmental operations are efficient and accurate. The position also requires identifying process improvements and fostering interdepartmental collaboration. The role leads, coaches, and mentors Billing & Authorization Staff.
Requirements
- At least a Bachelor’s Degree in a healthcare or business related discipline, or equivalent experience.
- At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity.
- Knowledge of medical billing and ICD-10, and CPT coding.
- Knowledge of financial concepts.
- Strategic focus, with the ability to identify and execute on key business strategies.
- Ability to effectively lead, coach, manage, mentor and develop others, holding staff accountable as appropriate.
- Excellent interpersonal skills, with the ability to communicate effectively with others.
- Able to work both independently and be self-directed, as well as being able to perform in a team atmosphere.
- Displays professionalism and represents organization in a professional manner.
- Strong knowledge of HIPPA privacy and security rules and regulations.
Nice To Haves
- Certification is a plus.
- Previous management level experience preferred.
Responsibilities
- Oversight of all credentialing activities, including completion and submission of applications and follow-up with providers and payors.
- Working with payors to add new locations to existing contracts.
- Maintaining good working relationships with payor contacts.
- Performing initial review of new payor contracts and suggesting changes.
- Acting as a credentialing resource for providers.
- Ensuring department operations are performed accurately and timely.
- Identifying and suggesting process improvement goals.
- Developing and maintaining partnerships across departments, partners, and vendors to support business objectives.
- Leads, coaches, and mentors Billing & Authorization Staff.
Benefits
- medical and dental insurance
- employer-matched 401(k)
- paid time-off
- paid travel
- short-term disability
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
251-500 employees
