Credentialing/Payor Specialist
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Job Description
Credentialing and payor enrollment specialist reducing denials for Capitol Imaging Services’ diagnostic imaging network. Managing provider enrollment, compliance, and reimbursement process improvements remotely.
Responsibilities:
- Develop and execute strategies to reduce insurance denials and payer write-offs
- Identify, analyze, and prioritize denial and non-payment root causes across modalities, payers, and sites
- Design and implement systematic solutions to prevent recurring denials
- Identify denial trends and convert them into operational SOPs
- Follow up with payers to resolve claim denials and payment discrepancies
- Investigate payment and reimbursement delays and support accurate claims processing
- Monitor and track outstanding accounts receivable
- Collect, verify, maintain, and update facility and provider credentials
- Prepare and submit initial and re-credentialing applications
- Maintain electronic credentialing files and track credential expirations and renewals
- Submit provider enrollment applications for Medicare, Medicaid, and commercial payors
- Manage enrollments through CAQH, PECOS, NPPES, and payor-specific portals
- Follow up with payors regarding delays, missing documentation, and application deficiencies
- Confirm provider participation status and effective dates
- Maintain up-to-date fee schedules
- Update payors on provider demographics, locations, group affiliations, and tax information
- Maintain compliance documentation for audits and internal reviews
- Partner with billing, revenue cycle, and leadership teams to resolve credentialing- and enrollment-related claim issues
- Communicate with internal teams via email, phone, and virtual meetings
- Manage workload independently while meeting deadlines and productivity expectations
Requirements:
- Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics
- 5+ years of experience in provider credentialing, payor enrollment, and denial management
- Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes
- Proven success reducing denials and write-offs
- Ability to manage multiple providers and deadlines independently in a remote setting
- Excellent written and verbal communication skills
- Highly detail-oriented and deadline-driven
- Comfortable with frequent follow-ups and documentation tracking, particularly in AR
- Proficient with Microsoft Office and web-based systems
- Self-motivated and able to work independently in a remote environment
- Maintains confidentiality and professionalism
- Reliable internet access
- Ability to maintain a secure, HIPAA-compliant remote work environment
Benefits:
- Fully remote work arrangement
- Secure, HIPAA-compliant remote work environment
- Flexible independent workload management
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