What are the responsibilities and job description for the Medical Provider Payer Credentialing Specialist position at Anesthesia Billing, Inc?
Overview
We are seeking a dedicated and detail-oriented Medical Provider Payer Credentialing Specialist to join our healthcare administration team. This role is vital in ensuring that healthcare providers are properly credentialed and authorized to deliver services within various insurance networks and managed care organizations. The ideal candidate will possess a strong understanding of medical billing, insurance processes, and credentialing standards, with a focus on maintaining compliance with industry regulations such as NCQA (National Committee for Quality Assurance) standards. This position offers an opportunity to contribute to the efficiency and integrity of provider enrollment processes, supporting high-quality patient care delivery.
Responsibilities
- Manage the end-to-end credentialing process for healthcare providers, including application submission, follow-up, and documentation verification.
- Ensure timely renewal and re-credentialing of providers in accordance with payer requirements and regulatory standards.
- Maintain accurate records of provider credentials, licenses, certifications, and other necessary documentation within credentialing databases.
- Collaborate with medical offices, insurance payers, and internal teams to resolve credentialing issues promptly and efficiently.
- Monitor compliance with NCQA standards and other accreditation requirements related to provider credentialing.
- Review managed care contracts and verify provider participation status across multiple insurance networks.
- Stay current on industry changes, payer policies, and regulatory updates affecting provider credentialing procedures.
Qualifications
- Proven experience in managed care or medical office settings with a focus on provider credentialing or enrollment.
- Strong knowledge of medical terminology, insurance processes, and credentialing requirements.
- Familiarity with NCQA standards and industry best practices for healthcare accreditation.
- Excellent organizational skills with meticulous attention to detail to ensure accuracy in documentation.
- Ability to communicate effectively with medical professionals, insurance representatives, and internal stakeholders.
- Prior experience working with credentialing software or databases is preferred.
- Demonstrated ability to manage multiple tasks efficiently while adhering to strict deadlines. Join us in supporting healthcare excellence by ensuring providers are properly credentialed to deliver high-quality care across diverse insurance networks!
Pay: $18.00 - $25.00 per hour
Benefits:
- AD&D insurance
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
Experience:
- payer enrollment: 1 year (Preferred)
Work Location: In person
Salary : $18 - $25