Credentialing and Insurance Specialist

Job description: Overview Join our dynamic healthcare team as an Insurance and Credentialing Specialist, where your expertise will be pivotal in ensuring seamless insurance processes and credentialing operations. In this role, you will manage insurance verifications, credentialing applications, and compliance with industry standards, all while supporting the delivery of high-quality patient care. Your proactive approach and attention to detail will help streamline administrative workflows, enhance provider credentials, and uphold the organization's commitment to excellence. Responsibilities Manage provider credentialing and re-credentialing activities in accordance with industry standards such as NCQA (National Committee for Quality Assurance). Maintain up-to-date records of provider licenses, certifications, and credentials to ensure compliance with regulatory requirements. Collaborate with managed care organizations to resolve billing issues, authorization requests, and claims denials efficiently. Review medical documentation and terminology to ensure accuracy in insurance submissions and credentialing files. Assist in preparing documentation for accreditation audits, including adherence to NCQA standards. Support onboarding of new providers by verifying credentials and completing necessary credentialing paperwork promptly. Negotiate insurance contracts on behalf of the practice to maintain best reimbursement models. Requirements Proven experience in managed care environments or medical office settings with a focus on insurance processing and credentialing. Strong understanding of medical terminology and healthcare billing procedures. Familiarity with NCQA standards and accreditation processes related to healthcare organizations. Excellent organizational skills with keen attention to detail for managing multiple credentialing files simultaneously. Ability to navigate various insurance portals, databases, and credentialing software efficiently. Effective communication skills for liaising with providers, insurance companies, and internal teams. Prior experience working in a fast-paced healthcare environment is preferred. Embark on a rewarding career where your skills contribute directly to improved patient experiences and organizational success!

Benefits:

401(k) matching Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person