Credentialing Specialist

Claims SpecialistClaims SpecialistFull TimeRemoteMid LevelTeam 1,001-5,000

Location

United States

Posted

8 days ago

Salary

$50K - $55K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Credentialing Specialist

TapestryHealth

Role Description The Credentialing Specialist is responsible for managing the credentialing, recredentialing, licensing, and payer enrollment processes for healthcare providers to ensure uninterrupted patient care and compliance with all regulatory requirements. This role requires meticulous attention to detail and the ability to work collaboratively with internal teams, providers, and payer representatives. As our business continues to grow, the scope of responsibilities may evolve to meet organizational needs. This is a Full-Time TEMP to PERM position. - Accurately maintain and update provider credentialing and payer enrollment records in CAQH, PECOS, credentialing software, and other payer-specific systems across multiple states. - Manage and monitor all aspects of the payer enrollment and re-enrollment process to ensure timely and successful participation with contracted insurance plans. - Analyze provider credentialing and enrollment files for completeness, accuracy, and compliance; identify and resolve any discrepancies or deficiencies. - Collaborate closely with internal teams (billing, contracting, operations, and clinical) to align credentialing and payer enrollment processes with organizational timelines. - Develop and maintain positive working relationships with payer representatives, providers, and third-party organizations to expedite application processing and issue resolution. - Serve as a resource for providers by responding to inquiries via phone, email, or internal communication channels in a timely and professional manner. - Track application status, monitor expirables, and ensure compliance with federal, state, and payer-specific regulations. - Assist with audits, special projects, and process improvement initiatives related to credentialing and payer enrollment. Qualifications - 2+ years in provider credentialing. - Working knowledge of payer enrollment processes, timelines, and requirements for commercial and government insurance plans. - Experience using credentialing/enrollment software (i.e., Modio, VerityStream, Cactus, MD-Staff) preferred. - Strong organizational skills and ability to manage multiple applications and deadlines simultaneously. - Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and comfort navigating web-based portals. - Demonstrated ability to maintain strict confidentiality and comply with HIPAA regulations. - Ability to work independently and as a collaborative team member in a fast-paced, evolving environment. - Experience managing collaborative practice agreements preferred. Requirements - The anticipated salary range for this role is $50K-$55K annualized. - This remote position follows a location-based compensation structure. - The posted salary range represents the potential pay range across the geographic markets. - Actual compensation will be determined based on the candidate’s experience, qualifications, and internal equity considerations, in accordance with applicable pay transparency laws.

Related Categories

Related Job Pages

More Claims Specialist Jobs

Real Garant by Zurich logo

Specialist Claims, Poland

Real Garant by Zurich

We love making customer loyalty in the mobility industry an extraordinary experience.

Full TimeRemoteTeam 201-500Since 1987H1B No Sponsor

• Technical point of contact for warranty cases, by phone and in writing • Verification of the plausibility of damage reports and independent claim assessment • Processing and monitoring of automated data imports in the warranty domain • Management of external partners such as appraisers • Monitoring and ensuring transparent cost control • Communication with dealerships, manufacturers, experts and warranty claimants

Poland

Taxonomy Specialist

SAIC

SAIC® is a premier mission integrator focused on advancing the power of technology and innovation to serve and protect our world. Our robust portfolio of offerings across the defense, space, intelligence, and civilian markets includes secure high-end solutions in mission IT, enterprise IT, engineering services, and professional services. We integrate emerging technology, rapidly and securely, into mission critical operations that modernize and enable critical national imperatives. We are approximately 23,000 strong; driven by mission, united by purpose, and inspired by opportunities. SAIC is an Equal Opportunity Employer. Headquartered in Reston, Virginia, SAIC has annual revenues of approximately $7.3 billion. For more information, visit saic.com . For ongoing news, please visit our newsroom .

Role Description SAIC is looking for a Taxonomy Specialist to help confer with GAO staff to apply GAO Product Taxonomy terms that describe the topical focus of individual products (audit reports, testimonies, legal decisions, and special publications). - Implement decisions about term assignments made during discussions with GAO subject matter experts. - Apply judgment to edge cases where standard term assignments are ambiguous or where new subject areas have emerged. - Notify GAO when taxonomy term information is missing, incorrect, or inconsistent and update as appropriate. - Perform data entry and quality assurance for taxonomy fields across multiple designated GAO systems. - Maintain accuracy and consistency of taxonomy records in PoolParty and USOrg, GAO's primary taxonomy management systems. - Support maintenance and expansion of taxonomies as needed to facilitate topical access to GAO products, internal materials, and other content. - Assist in maintaining and expanding the GAO Product Taxonomy to include sub-topics and product types not currently covered, such as decisions and other legal products. - Advise on and assist in creating SOP documents to accurately reflect taxonomy system changes. - Manipulate taxonomies to produce reports, specialized lists, and other output as requested. Company Description SAIC® is a premier mission integrator focused on advancing the power of technology and innovation to serve and protect our world. Our robust portfolio of offerings across the defense, space, intelligence, and civilian markets includes secure high-end solutions in mission IT, enterprise IT, engineering services, and professional services. We integrate emerging technology, rapidly and securely, into mission critical operations that modernize and enable critical national imperatives. - We are approximately 23,000 strong; driven by mission, united by purpose, and inspired by opportunities. - SAIC is an Equal Opportunity Employer. - Headquartered in Reston, Virginia, SAIC has annual revenues of approximately $7.3 billion. For more information, visit saic.com . For ongoing news, please visit our newsroom .

United States
Full TimeRemoteTeam 1-10Since 2018H1B No Sponsor

• Collaborate as a member of the Epic analyst team, providing developer-level support • Apply deep understanding of professional billing and claims applications to optimize system performance • Troubleshoot and resolve break/fix issues within the PB and Claims modules • Implement application enhancements to improve efficiency, compliance, and user experience • Work effectively within an established team structure, contributing to shared goals • Partner with the manager to prioritize tasks and deliverables

California
$120K - $130K / year
Full TimeRemoteTeam 5,001-10,000H1B Sponsor

Role Description We are seeking an experienced Bodily Injury Claims Adjuster to join our growing team. This role is responsible for the investigation, evaluation, negotiation, and resolution of complex third-party liability claims involving bodily injury, personal injury, and allegations of wrongdoing. Claims may include: - General Liability - Auto Liability - Errors & Omissions - Law Enforcement Liability The ideal candidate will possess strong investigative skills, excellent judgment, a customer-focused approach, and the ability to independently manage claims through resolution while maintaining compliance with client requirements and applicable regulations. Qualifications - College degree or equivalent claims experience preferred. - Active Adjuster License required or ability to obtain and maintain appropriate licensing. - Minimum of 3+ years of bodily injury claims handling experience. - Experience handling: - Auto Liability Claims - General Liability Claims - Errors & Omissions Claims - Law Enforcement Liability Claims - Strong understanding of: - Tort law - Liability analysis - Bodily injury evaluation - Medical terminology - Coverage interpretation - Litigation management - Experience independently handling claims from assignment through closure. - Experience working with defense counsel and litigated files preferred. - Knowledge of Medicare reporting requirements and excess carrier reporting procedures preferred. - Familiarity with ISO ClaimSearch and industry-standard claims platforms. - Excellent negotiation and settlement skills. - Exceptional written and verbal communication abilities. - Strong organization, documentation, and time management skills. - Ability to prioritize multiple assignments in a fast-paced environment. - Strong analytical, investigative, and problem-solving skills. - Proficiency with Microsoft Office Suite and claims management systems. - Ability to work independently with minimal supervision while maintaining high-quality claim outcomes. Requirements - Investigate, evaluate, negotiate, and resolve third-party bodily injury and liability claims in accordance with client guidelines and Davies best practices. - Review all new claim assignments within 24 hours and develop an appropriate plan of action. - Contact insureds, claimants, attorneys, and other involved parties within 24 hours of claim assignment. - Conduct thorough investigations to determine liability, causation, damages, and exposure. - Obtain recorded statements from claimants, insureds, witnesses, and other involved parties as necessary. - Gather and evaluate evidence, including medical records, photographs, police reports, expert reports, and witness statements. - Coordinate appraisals, damage estimates, and field investigations when required. - Determine injury status of all parties involved in claims and accident investigations. - Analyze coverage, liability, damages, and settlement exposure. - Evaluate claims involving attorneys and determine the appropriate level of legal involvement. - Negotiate settlements within authority and seek payment authorization in accordance with client and company requirements. - Maintain accurate reserves and recommend adjustments based on claim development. - Manage litigated claims and coordinate with defense counsel when assigned. - Immediately notify management and clients of any Summons and Complaint received. - Monitor defense counsel performance and obtain status updates at minimum 90-day intervals. - Review field adjuster reports for thoroughness, accuracy, and completeness. - Run ISO ClaimSearch reports on injured claimants and evaluate findings as appropriate. - Report qualifying claims to excess carriers and provide timely status updates. - Respond to Reservation of Rights inquiries and carrier communications as needed. - Develop and maintain working knowledge of No-Fault/PIP statutes and regulations. - Ensure Medicare reporting compliance and follow company guidelines when resolving claims involving Medicare recipients. - Review claims for compliance with applicable sovereign immunity statutes and governmental liability requirements, including Florida Statute 768.28 when applicable. - Maintain complete and timely claim documentation, file notes, correspondence, and workflow activities. - Maintain diary systems and follow-up schedules to ensure timely claim progression and closure. - Meet established service standards, closure goals, productivity expectations, and quality metrics. - Maintain required adjuster licenses and continuing education credits. - Assist colleagues, supervisors, and management with special projects and claim-related support as needed. Benefits - Medical, dental, and vision plans to support your health and that of your family. - A 401(k) plan with employer matching. - Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees. - Paid holidays. - Life insurance and short-term and long-term disability coverage. - Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws. - Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

United States
$67K - $70K / year