Credentialing Specialist
Job Location:
Terrell, TX - USA
Hourly Salary:
Posted on:
Vacancies:
Job Summary
At Emergicon youll join a people-first team doing purpose-driven work that directly supports EMS and fire departments across the stateand the communities that depend on them.
The Credentialing & Reimbursement Specialist is responsible for coordinating monitoring and maintaining provider enrollment re-enrollment revalidation and ERA/EFT processes in a timely and compliant manner.
This position reports directly to the Credentialing Assistant Manager and collaborates with Emergicon personnel across all departments.
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 multi-providers
Maintain and update provider licenses and insurance addresses
Prepare enrollment applications for all health plans including Medicare and Medicaid
Complete and distribute W-9 forms
Demonstrate problem-solving and customer service skills
Ability to understand analyze and interpret complex documents
Other job-related 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 third-party reimbursement and revalidation processes
Ability to work within a deadline-intense environment prioritizing workflow as needed.
Must be able to communicate clearly and professionally verbally and in writing.
Required Experience:
IC
About Company
PRIMARY FUNCTIONSThe Helpdesk Analyst II is responsible for providing frontline technical support to end-users, ensuring smooth daily IT operations across...
