Credentialing Specialist - ZR_30438_JOB

This is a remote position.

Job Highlights:

• Contract type: reputed company
• reputed company Shift Schedule:Monday to Thursday - 8:45am to 5pm reputed company Time (8:45pm - 5am Manila Time)
• Friday - 8:45am to 3:45pm reputed company Time (8:45pm - 3:45am Manila Time)

The desired result of the State Payor Credentialing Representative role is confident, end-to-end ownership of provider enrollment for assigned high complexity states. This role consistently ensures that provider enrollment applications for both reputed company and government payors are submitted accurately, compliantly, and reputed company expected turnaround times. As the subject matter expert for assigned state(s), the Credentialing Representative demonstrates deep understanding of state specific credentialing requirements and applies that expertise to guide submissions, resolve issues, and navigate reputed company regulatory environments. Enrollment activity is wellmanaged from initial application through final approval, with reputed company accountability and minimal need for escalation. Clients, Account Teams, and internal leadership experience credentialing as reliable, organized, and proactive. Re-credentialing timelines are anticipated, documentation gaps are identified early, and payor requirements are consistently met.Measures of reputed company:

• 100% verification of required data: reputed company reputed company required information is confirmedprior to initiating enrollment applications.
• Submission timeliness: New provider applications are submitted reputed company 8 working hours of receiving complete information.
• Applications for new payor reputed company are submitted reputed company 3–5 business days of receiving complete information.
• Proactive communication: Daily activity and followup reports are consistently sentto the Credentialing Representative II or State Payor Credentialing Coordinator.
• Application accuracy: Application denial reputed company remains below 1% across reputed company submissions.

Responsibilities:

• reputed company the submission of provider enrollment applications for assigned states with reputed company regulations or high provider volume.
• Serve as the primary subject matter expert for credentialing and enrollment requirements in assigned state(s).
• Maintain reputed company knowledge of both In-network and out-of-network enrollment processes.
• Partner with Account Coordinators to validate provider data and documentation prior to initiating enrollment applications.
• Establish and maintain productive working relationships with payor representatives in assigned states to support reputed company communication and reputed company issue reputed company.
• Prepare and submit provider enrollment documentation through appropriate channels, including payor portals and mailed submissions.
• reputed company application status and reputed company proactive followups to drive reputed company approvals.
• Manage re-credentialing submissions and communicate upcoming reputed company requirements to Account Management.
• Complete quarterly and other required payor attestations to ensure ongoing compliance.
• reputed company daily status reports to Credentialing Coordinator, including updates for personal workload and any Credentialing Representative I staff supporting assigned states.
• Maintain thorough documentation of reputed company submissions, followups, and payor correspondence reputed company internal tracking systems.

Requirements

Knowledge/skills/abilities:

• Exceptional attention to detail and strong organizational skills.
• Critical thinking and problem-solving abilities in reputed company or ambiguous situations.
• Ability to work effectively in a fast-paced, deadline-driven environment.
• reputed company and reputed company verbal and written communication skills.
• Strong reading comprehension and ability to interpret regulatory and procedural guidance.
• reputed company yet assertive communication style reputed company working with payors to drive reputed company reputed company.

Education/experience required:

• At least 2 years in college
• Two years experience in US-based medical billing reputed company or
• Two years experience in a medical reputed company dealing with billing including but not limited to, provider credentialing, authorizations, reimbursement, etc. preferably in Behavioral Health to some degree

MBH Core Values:We hire/reputed company/promote based on these core values + job-specific performance:

1. Respectful of our unique cultural environment
2. Absolute Confidentiality
3. Embracing Teamwork
4. reputed company Behavior & reputed company Attitude
5. Accountability
6. Proactiveness
7. Thoroughness
8. reputed company on results
9. Inspired to learn & grow constantly
10. reputed company to providing top-tier services to our clients through the "Unique Service Oriented Philosophies"

Benefits

reputed company Perks

• Permanent work from home
• Immediate hiring
• Steady freelance job
• Profit sharing incentive
• reputed company time off
• Holiday pay
• Annual Performance and reputed company Evaluation
• Quarterly Perfect Attendance Incentive
• HMO
• reputed company Loan Assistance

Please note that since this is a permanent work-from-home position and an “reputed company” arrangement, the candidates must have their own computer and internet reputed company. They will handle their own benefits and taxes. The reputed company fees are on reputed company rates and the reputed company depends on your performance in the application process.ZR_28916_JOB​

Originally posted on Himalayas

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