Payor/ Credentialing Specialist

Kane County Human Resource SPE•Kanab, UT

About The Position

The Part-Time Payor Credentialing Specialist is responsible for managing and maintaining provider credentialing and recredentialing with insurance payors, government agencies, and healthcare networks. This role ensures providers remain compliant and enrolled with all contracted payors to support uninterrupted billing and reimbursement.

Requirements

High school diploma or equivalent required; associate degree preferred.
Previous experience in healthcare credentialing, medical billing, or provider enrollment preferred.
Knowledge of CAQH, PECOS, Medicare, Medicaid, and commercial insurance processes.
Strong attention to detail and organizational skills.
Proficiency with Microsoft Office and credentialing software systems.
Ability to manage multiple deadlines and work independently.
Excellent written and verbal communication skills.

Nice To Haves

Experience with physician or behavioral health credentialing.
Familiarity with HIPAA and healthcare compliance standards.
Ability to troubleshoot enrollment and billing issues efficiently.

Responsibilities

Complete and submit provider credentialing and recredentialing applications.
Maintain accurate provider records in credentialing databases and CAQH.
Monitor credential expiration dates, licenses, certifications, malpractice insurance, and other required documents.
Follow up with insurance companies regarding application status and approvals.
Coordinate provider enrollment with Medicare, Medicaid, and commercial payors.
Ensure compliance with federal, state, and organizational credentialing requirements.
Update provider information with payors as needed.
Resolve credentialing-related claim denials and enrollment issues.
Maintain organized electronic and paper credentialing files.
Communicate effectively with providers, office staff, and insurance representatives.
Prepare reports on credentialing status and outstanding items.