Medical Insurance Credentialing Specialist

📋 Description

• Prepare and submit credentialing applications for new healthcare providers across commercial
• Manage provider re-credentialing within required timelines to prevent lapses in insurance network
• Maintain accurate provider information in credentialing databases, payer portals, and related
• Coordinate with providers to collect required documentation, professional licenses, certifications
• Review, prepare, and submit medical insurance claims accurately using electronic health record
• Apply appropriate CPT, HCPCS, and ICD-10 codes, including relevant modifiers, in accordance with

🎯 Requirements

• High school diploma or equivalent required; an associate or bachelor's degree in healthcare
• At least two years of experience in medical credentialing, medical billing, or both, preferably
• Strong working knowledge of commercial insurance, Medicare, Medicaid, and managed care
• Familiarity with CAQH ProView, NPPES, PECOS, Availity, payer portals, and EHR or medical billing
• Demonstrated experience preparing accurate claims, resolving denials, following up on outstanding
• Understanding of CPT, ICD-10, and HCPCS coding systems, including modifier requirements.

🎁 Benefits

• Fully remote work arrangement.
• Full-time employment.
• Standard Monday-to-Friday business hours.
• Opportunity to develop expertise across provider credentialing, medical billing, insurance claims
• Collaborative work with healthcare providers and administrative, clinical, and revenue cycle
• Opportunity to contribute to improved reimbursement accuracy, regulatory compliance, and