Oct 21, 2024

Credentialing Specialist

Contract Other

Job Description

Hello!

Are you passionate about helping businesses clean up their old claims? Do you find it rewarding to efficiently resolve billing issues? If you love tackling unique challenges and using your problem-solving and analytical skills, we have the perfect opportunity for you!

Join pMD as a flexible contract specialist, where you can enjoy:

  • Complete Flexibility: No minimum working hours or daily requirements. Work as much or as little as you want!
  • First Come, First Serve: Secure work on your schedule, based on availability.
  • Meet Your Goals: Balance your workload to meet your compensation targets.

Take control of your work-life balance and make a meaningful impact in the world of medical billing. Ready to jump in?

We are currently only accepting applications through our website. Please click the application link below if you'd like to be considered.

(Contract) Credentialing Specialist:

(Contract) The Credentialing Specialist Contractor role at pMD is responsible for completing contracting and credentialing applications, claims and remittance agreements, EFT enrollment applications, changes in medical practice information, participation status, roster updates, and follow up calls on these tasks. This entails transcribing practice and individual provider data into PDF forms or portal-based forms. This plays a vital role in maintaining accuracy and efficiency with our credentialing process. By diligently completing and following up on applications, our team helps to ensure that our carrier network remains robust and our clients receive the highest quality service. 

Responsibilities include:

  • complete requests to contract and credential with insurance carriers
  • complete applications for group contracting and individual provider credentialing with insurance carriers
  • complete initial and reappointment applications for privileges at healthcare facilities
  • request changes in practice demographic information with insurance carriers
  • complete claims and remittance agreements via clearinghouse software and payer portals
  • complete and submit Electronic Funds Transfer enrollments to establish electronic payments from the insurance carriers
  • perform outreach to insurance companies to confirm status of applications and other change requests, including changes in medical practice information, participation status, and status of roster updates
  • review previous notes pertaining to credentialing requests in order to achieve the goal of each outreach attempt
  • record details about outbound calls to insurance carriers using task management software
  • document clear instructions regarding the next steps for the credentialing specialist when applicable
  • communicate regularly with the Credentialing Department regarding any urgent matters, as well as weekly availability

Requirements include:

  • must have experience completing contracting/credentialing applications and outreach
  • experience/exposure to completing EDI agreements, preferred
  • experience/exposure to completing EFT agreements, preferred
  • availability during insurance carrier business hours (Monday - Friday, 8 am - 5 pm EST)
  • knowledge of basic medical credentialing and administrative terminology
  • exceptional attention to detail
  • must be able to work independently in a fast-paced environment
  • strong communication and problem solving skills
  • reside in the US

The compensation model for this role is designed to pay on a per-unit of completed work basis, allowing ultimate flexibility in how and when you want to work. The per work item rates are as follows:

Follow-Up Call: $3.98/unit
Initial Hospital Privileges: $13.44/unit
Address Update: $2.98/unit
Roster Update/Initial Request/Link Provider: $5.97/unit
Initial Contracting/Credentialing Application: $13.44/unit
Re-credentialing/Reappointment Application: $8.96/unit
CAQH Attestation: $2.98/unit
ERA Enrollment: $5.97/unit
EFT Enrollment: $5.97/unit
Candidates must be authorized to work in the U.S. as a precondition of employment.

Required Experience Level

Intermediate Level

Minimum Education

No formal education required

Minimum Experience Required

0-2 years

Required Travel

No required travel

Applicant Location

US residents only