Insurance Credentialing Specialist
1 day ago
The Insurance Credentialing Specialist at NAPA Center plays a crucial role in ensuring the smooth operation of our therapy services. This position is responsible for overseeing the credentialing and re-credentialing process, ensuring that all therapists are properly enrolled and in good standing with insurance companies. The specialist will manage applications, renewals, and maintain accurate credentialing records in relevant databases, working closely with therapists and insurance providers to resolve any credentialing issues.
Key Responsibilities- Manage enrollments, re-credentialing, and execute new contract applications with commercial and government health plans.
- Maintain comprehensive knowledge of managed care company and plan requirements to ensure efficient and timely credentialing of providers.
- Effectively communicate the contracting and enrollment process, addressing client and staff inquiries, and providing regular status updates to internal teams and external stakeholders.
- Coordinate the credentialing process for healthcare providers with various insurance payers, ensuring compliance with regulatory requirements and internal protocols.
- Maintain accurate provider records in credentialing databases, updating all relevant information promptly.
- Respond to inquiries from healthcare providers, payers, and internal departments regarding credentialing status and guidelines.
- Monitor and ensure the accuracy of credentialing files, flagging and resolving any discrepancies proactively.
- Stay up-to-date with any Medicaid and Commercial plans guidelines changes.
- Collaborate with Billing Specialists to resolve credentialing issues affecting claim submissions and reimbursements.
- Maintain professionalism and respect in interactions with all internal and external stakeholders, fostering a positive and collaborative working environment.
- High School Diploma (or GED).
- Minimum 3 years of experience in physician credentialing or health insurance credentialing.
- Familiarity with the insurance enrollment process for various payers, including Medicare, Medicaid, and private insurers.
- Strong project management abilities, with the capacity to manage multiple applications and collaborate with payers to meet deadlines.
- Excellent attention to detail and organizational skills.
- Exceptional verbal and written communication skills.
- Knowledge of federal, state, and local legal and regulatory provisions related to credentialing.
- Proficiency in CPT/HCPCS/ICD-9/ICD-10.
- EMR/RT knowledge preferred but not required.
- Certified Provider Credentialing Specialist (CPCS) certification preferred but not required.
The physical demands of this remote position primarily involve extended periods of sitting and working at a computer. This role may require the employee to:
- Sit or stand at a desk for prolonged periods, often between 6–8 hours per day.
- Frequently use standard office equipment, such as a computer, keyboard, mouse, and telephone.
- Occasionally lift and carry items weighing up to 10 pounds.
- Maintain focus on a computer screen and handle repetitive movements such as typing and mouse usage.
- Participate in virtual meetings, requiring active listening and effective communication.
All NAPA Center employees must demonstrate the company's core values which include:
- Love – NAPA's foundation is grounded in the deep love parents have for their children. Together, we strive to infuse kindness and care into our actions and words, creating a supportive community built upon love.
- Hope – We believe in the potential of every child and are committed to offering unwavering support to our families, guiding them toward success, and inspiring hope.
- Share – We strive toward progress and connection through continuous collaboration among team members, as well as with our clients and their families.
- Grow – Embrace evolution, active engagement, and perpetual pursuit of knowledge from our clients, colleagues, and industry. By doing so, we are committed to providing the most advanced and effective therapy, ensuring the continual improvement of our services.
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