Credentialing and Reimbursement Specialist
Credentialing and Reimbursement Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
The Credentialing & Reimbursement Specialist is responsible for coordinating monitoring and maintaining provider enrollment reenrollment revalidation and ERA/EFT processes in a timely and compliant manner.
Essential Duties And Responsibilities
Coordinate TMHP and Medicare (MCR) revalidation processes ensuring accuracy and compliance with deadlines
Set up payor sites for eligibility claim filing claim status ERA EFT and appeals
Establish and maintain group accounts for multiproviders
Maintain and update provider licenses and insurance addresses
Prepare enrollment applications for all health plans including Medicare and Medicaid
Complete and distribute W9 forms
Demonstrate problemsolving and customer service skills
Ability to understand analyze and interpret complex documents
Other jobrelated duties as assigned
Knowledge And Experience
High school diploma/GED required
Minimum of 2 years of provider enrollment experience preferred including TMHP and Medicare revalidation.
Ability to distinguish and explain an EFT ERA EOB COB and pay to address
Ability to read and understand payor applications and how payors work
Knowledge of federal and state insurance laws and their interpretation as appropriate
Knowledge of insurance claim processing thirdparty reimbursement and revalidation processes
Ability to work within a deadlineintense environment prioritizing workflow as needed.
Must be able to communicate clearly and professionally verbally and in writing.
Emergicon requires satisfactory preemployment drug screenings and background check.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
