Payer Credentialing Specialist

University of Texas at Austin•Austin, TX

11d•$50,000•Onsite

About The Position

The Payer Credentialing Specialist is responsible for managing the credentialing and re-credentialing processes for healthcare providers with various insurance payers. This role ensures that all provider credentials are accurate, up-to-date, and compliant with regulatory standards.

Requirements

High School Diploma/GED
At least 2 year(s) of experience in healthcare credentialing or provider enrollment.
Relevant education and experience may be substituted as appropriate.

Nice To Haves

Associate's Degree in healthcare administration or related field.
At least 4 year(s) of experience in payer credentialing or medical staff services.
Certified Provider Credentialing Specialist (CPCS) from NAMSS

Responsibilities

Manage the initial credentialing and re-credentialing processes for healthcare providers.
Verify provider credentials, including education, licensure, and certifications.
Ensure compliance with payer requirements and regulatory standards.
Submit and track provider enrollment applications with insurance payers.
Follow up with payers to resolve any issues or delays in the enrollment process.
Maintain accurate records of enrollment status and documentation.
Maintain and update credentialing databases and provider files.
Generate reports on credentialing status and compliance metrics.
Ensure data accuracy and integrity in all credentialing records.
Communicate with providers, payers, and internal departments to facilitate the credentialing process.
Address and resolve any credentialing-related inquiries or issues.
Provide regular updates to stakeholders on credentialing status.
Conduct audits with payers as per delegated credentialing agreements and implement corrective action plans as needed.
Ensure compliance with all regulatory and accreditation requirements.
Participate in audits and quality assurance activities.
Implement process improvements to enhance credentialing efficiency and accuracy.