Credentialing Specialist

Contracting/Credentialing/Payor Enrollment:

• Create, maintain, and organize payor and provider document copies, NPPES/Licensing Board/CAQH/DEA and other required profiles.
• Prepare and submit individual provider applications, rosters, and group applications for payor enrollment.
• Maintain open communication with providers, payers, and internal stakeholders to resolve credentialing and enrollment issues related to provider files.

Billing and Invoicing:

• Ensure client invoices and claims are properly documented, approved, and sent on schedule.
• Provide member/insurance revenue management support throughout the revenue cycle, to include Claims Management, Accounts Receivable, Payment Posting and Denials Management.
• Maintain open communication with providers, payers, and internal stakeholders to resolve insurance eligibility and benefits, as well as claims issues.

Financial Recordkeeping:

• Maintain organized financial records, including invoices and bills.
• Collaborate on reconciling accounts and resolving discrepancies.
• Assist in generating regular reports on payment status and financial performance.