Provider Credentialing & Accounts Receivable Specialist
Provider Credentialing & Accounts Receivable Specialist
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Job Description
Now Hiring: Provider Credentialing & Accounts Receivable Specialist
Location: Linthicum MD
Reports To: Vice President RCM Operations
Employment Type: Full-Time
CoreLife is seeking a detail-oriented and highly motivated Provider Credentialing & Accounts Receivable Specialist to join our team. This dual-function role is critical in ensuring accurate provider enrollment maintaining credentialing compliance and supporting revenue cycle operations. If you have a strong background in medical credentialing payer enrollment and A/R managementand enjoy working in a fast-paced mission-driven environmentwed love to hear from you!
Key Responsibilities
Credentialing & Enrollment:
Prepare and submit provider enrollment applications and supporting documentation across multiple payers.
Maintain accurate and compliant records for licenses certifications and insurance contracts.
Track and process new enrollments revalidations ERN/ERA submissions and roster updates.
Coordinate with HR providers and billing teams to streamline onboarding and credentialing processes.
Manage CAQH profiles and update PECOS and NPPES as needed.
Maintain HIPAA-compliant credentialing files and communication with payer credentialing teams.
Accounts Receivable Management:
Review and manage aging A/R > 30 days ensuring timely follow-up and maximum reimbursement.
Address denied claims rework errors file appeals and communicate with payers as needed.
Monitor payer reimbursements against contracted rates.
Provide coverage and support across the team during absences or high-volume periods.
Work within EPIC and NextGen systems and utilize EMR tools for charge entry and collections tracking.
Qualifications
Required:
High school diploma or equivalent.
Minimum 3 years of experience in provider credentialing and/or medical billing.
Experience with PECOS and ePREP.
Knowledge of payer requirements and CPT/ICD-10 coding.
Preferred:
Associate or Bachelors degree in healthcare business or related field.
5 years of experience in credentialing and A/R management.
Experience with EPIC and NextGen.
Familiarity with NCQA standards and processes.
Skills & Abilities
Exceptional attention to detail and organizational skills.
Ability to multitask prioritize and work independently.
Strong problem-solving and critical thinking capabilities.
Excellent communication and interpersonal skills.
Proficiency with Microsoft Excel and payer web portals.
Commitment to confidentiality and HIPAA compliance.
Why CoreLife
At CoreLife we are committed to delivering exceptional patient outcomes and creating a supportive respectful environment for our team. Youll be part of an innovative growing company dedicated to transforming healthcare through integrated whole-person care.
Required Experience:
Junior IC
Employment Type
Full-Time
