Provider/Payer Enrollment Specialist

3 weeks ago

Katy, United States MedRevenu, LLC Full time $18 - $23
*About Us:*

Hit Apply below to send your application for consideration Ensure that your CV is up to date, and that you have read the job specs first.

MedRevenu is a rapidly-expanding physician medical billing company located in Upland, CA. We have been helping doctors with their financial performance for more than 16 years and due to our continued growth, we have an immediate need for a full-time credentialing specialist.

As a credentialing specialist, you will be initiating, tracking, and following up on all credentialing applications required by each of our client's payer portfolio to ensure reimbursement for all services performed for all identified providers.

*Your Role as a Credentialing Specialist Will Include:*

* End-to-end credentialing process of all clients’ providers, and with all payers within each client’s payer portfolio.
* Requesting all documentation required from clinicians to ensure the timely submission of all credentialing applications, including but not limited to licensure, malpractice insurance, NCQA and other accreditations, DEA and other certifications, etc.
* Initiating credentialing and re-credentialing applications for all payers and plans, both individual and group, including but not limited to Medicare, Medi-Cal, Commercial Payors, Medi-Cal HMO's, etc.
* Ensuring all providers are added to the appropriate client’s existing group contracts.
* Facilitating the payment for all applications and renewal fees as requested by each client.
* Tracking all credentialing applications, from submission through final approval, following up with each payer on a routine basis to obtain application status, as well as move the credentialing process forward, escalating to senior leadership as required.
* Maintaining a spreadsheet of all clients’ providers and their associated credentialing and contracting information, including expirations, paying close attention to detail.
* Communicating with leadership and clients regarding impending expirations of credentialing for all providers associated with each client.
* Participating in various department and client meetings to provide feedback and address issues relating to the credentialing process.

*What We Are Looking For:*

* HS diploma or equivalent.
* Minimum 3 years of experience in healthcare credentialing, which may include experience credentialing various providers (physicians, nurse practitioners, physician assistants, counselors, etc.) for billing under various government, commercial, and other third-party payers.
* Knowledge of insurance contracting, payer regulations, managed care and compliance.
* Intermediate experience with interpreting EOBs, EOMBs, ERAs, RAs, and other related documents.
* Knowledge and understanding of ICD10, CPT, and HCPCS coding.
* Intermediate knowledge and experience with basic Microsoft programs including Word, Excel, and PowerPoint, with demonstrated ability to prepare letters, spreadsheets, charts and graphs, and various presentations.
* Research and analytical skills to identify and triage credentialing issues impacting billing and collection.
* Intermediate knowledge of in-house practices, system operations, and assigned client expectations.
* Ability to follow through on newly established and/or changes to existing policies, procedures, and workflows.
* Skill in performing all daily tasks independently, while working as part of a team, within a demanding environment.
* Ability to accept and carry out oral and written instructions accurately.
* Ability to prioritize work, handling multiple tasks to completion within the time allotted.
* Excellent interpersonal skills to communicate effectively and diplomatically with internal and external customers (and staff) both in person and over the telephone.
* Oral communication skills to speak clearly and distinctly in English, using appropriate vocabulary and grammar.
* English writing skills to prepare grammatically correct business documents.
* Excellent skill in performing under the stress of frequent interruptions and/or distractions.

*Desired/ Preferred Qualifications*

* Certifications in related healthcare billing and/or collection topics.
* Experience on MedInformatix and Office Ally.

*Benefits:*

* Health Insurance
* Dental Insurance
* Vision Insurance
* Paid Time Off
* 401(k) Plan

MedRevenu is proud to be an equal opportunity employer and considers qualified applicants for employment regardless of race, gender, gender identity, gender expression, age, religion, disability, veteran’s status, sexual orientation, or any other protected factor.

Learn more about MedRevenu at www.medrevenu.com.

Job Type: Full-time

Pay: $18.00 - $23.00 per hour

Expected hours: 40 per week

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday

Work Location: In person

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