Enrollment & Credentialing Specialist

Company Overview

Arbor is a leading laboratory specializing in diagnostic testing and healthcare services. We are committed to delivering accurate, timely results while ensuring seamless integration with insurance providers to support patient care and operational efficiency.

Position Summary

The Enrollment & Credentialing Specialist will play a critical role in the laboratory's revenue cycle management by facilitating the onboarding and credentialing of new insurance plans. This position involves coordinating with insurance companies, internal teams, and regulatory bodies to ensure compliance, timely enrollment, and smooth integration of new payers. The ideal candidate is detail-oriented, highly organized, and experienced in healthcare administration, with a focus on insurance credentialing processes.

Key Responsibilities

• Insurance Onboarding and Credentialing: Lead the end-to-end process of onboarding new insurance plans, including application submission, documentation gathering, and follow-up to secure approvals and contracts.
• Compliance and Regulatory Adherence: Ensure all credentialing activities comply with federal, state, and insurance-specific regulations (e.g., CAQH, PECOS, HIPAA). Monitor changes in payer requirements and update internal protocols accordingly.
• Documentation Management: Collect, review, and maintain accurate provider credentials, licenses, certifications, and other required documents for lab physicians, technicians, and the facility.
• Collaboration and Communication: Work closely with billing, finance, legal, and clinical teams to resolve credentialing issues. Serve as the primary point of contact for insurance representatives during the onboarding phase.
• Process Improvement: Identify opportunities to streamline onboarding workflows, reduce turnaround times, and implement best practices to enhance efficiency.
• Tracking and Reporting: Maintain detailed records of credentialing status using tracking systems or databases. Generate reports on onboarding progress, timelines, and potential bottlenecks for management review.
• Re-credentialing Support: Assist with periodic re-credentialing of existing insurance plans to maintain active status and prevent disruptions in billing.
• Issue Resolution: Investigate and resolve denials or delays related to credentialing, collaborating with payers to expedite resolutions.

What We Offer

• Competitive salary and benefits package, including health insurance, retirement plans, and paid time off.
• Opportunities for professional development and certification reimbursement.
• A collaborative work environment focused on innovation and patient-centered care.

Arbor is an equal opportunity employer. We encourage applications from diverse candidates. To apply, please submit your resume and cover letter to [email address] or visit our careers page.

This job description is intended to convey information essential to understanding the scope of the position and is not exhaustive. Duties and responsibilities may evolve as needed.

Qualifications

• Education: Bachelor's degree in Healthcare Administration, Business Administration, or a related field. Relevant certifications (e.g., CPCS - Certified Provider Credentialing Specialist) are highly preferred.
• Experience: Minimum of 2-3 years in healthcare credentialing, payer enrollment, or revenue cycle management, preferably in a laboratory or medical setting. Experience with insurance onboarding for diagnostic labs is a plus.
• Skills:
  • Strong knowledge of insurance credentialing processes, including applications for Medicare, Medicaid, and commercial payers.
  • Proficiency in credentialing software (e.g., CAQH ProView, Credential Stream) and Microsoft Office Suite (Excel, Word, Outlook).
  • Excellent organizational and multitasking abilities, with a keen eye for detail.
  • Superior communication skills, both written and verbal, for interacting with internal stakeholders and external partners.
  • Ability to work independently in a fast-paced environment while meeting strict deadlines.
• Other Requirements: Familiarity with healthcare regulations and privacy laws. Must be able to handle confidential information with discretion.