Senior Credentialing Specialist

Position Description

This position is responsible for ongoing credentialing initiation and verification process of our laboratories. Work directly with payers and external organizations to facilitate timely and effective credentialing laboratory applications. The Senior Credentialing Specialist will conduct initial credentialing and re-credentialing procedures plus search for opportunities to acquire credentialing in new markets. 

• Successful knowledge to negotiate contracts with healthcare insurance company

• Successful knowledge maintenance of credentialing and re-credentialing procedure for health care laboratories
• Ability to work independently, productively in a very busy environment
• Successful knowledge to enroll health care laboratories in to the close panel insurance plans.
• Have professional verbal and written communication skills. Work well under difficult circumstances and tight time lines.
• Create, maintain, and disseminate plan participation status and billing information to billing, managers, and executives to maximize collections in the revenue cycle management process.
• Researches and processes new health plans applications for laboratory.
• Manages health plans enrollments, increasing plan acceptance/participation
• Acts as internal resource around issues associated with public funding sources, such as Medicaid and Medicare, as well as private payors.

• Responsible for meeting set performance goals with regard to quality and accuracy of work
• Manages and prioritizes assigned work so that turnaround time goals are met, in process files are kept up-to-date, and assigned files are processed in a timely manner.

Requirements include:

• Excellent understanding of the provider credentialing process
• Extremely well organized and detail oriented with the ability to independently problem solve, and prioritize multiple tasks in a fast paced environment
• The ideal candidate will possess strong communication and interpersonal skills
• Must have a working knowledge of Microsoft Office, including Outlook and Word
• 5+ years in laboratory or medical practice credentialing
• Bachelor’s degree preferred; credentialing certification (CPCS) preferred. 

Additional knowledge and skills:

• Successful knowledge to enroll health care laboratories: 5 years
• Health Insurance Credentialing Specialist: 5 years
• Successful knowledge to negotiate contracts with healthcare: 5 years

Required licenses or certifications:

• * Certified Provider Credentialing Specialist
• 5 years of experience with credentialing healthcare

Salary and Benefits:

• Excellent work/life balance
• Competitive base salary
• Medical, Dental, Life

Prescient Medicine is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, marital status, disability or any other basis prohibited by law.