Job Closed

This listing is no longer active.

Froedtert logo
Froedtert

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

Senior Credentialing Specialist

Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 10,001

Location

United States

Posted

7 days ago

Salary

$23 - $34 / hour

Seniority

Senior

No structured requirement data.

Job Description

Senior Credentialing Specialist

Froedtert

Role Description The Senior Credentialing Specialist oversees and leads the credentialing and privileging processes with a focus on regulatory compliance, quality assurance, and process improvement. This role not only performs credentialing tasks but also: - Develops procedures - Mentors staff - Handles complex or escalated issues - Ensures ongoing compliance with accrediting bodies - Acts as a liaison with leadership - Contributes to audits, policy development, and strategic planning Qualifications - Minimum of 3 years of credentialing or healthcare-related experience - High School diploma or equivalent is preferred Requirements - Proficiency in Microsoft Office Suite and Windows applications - Familiarity with credentialing and terminology - Strong database management skills and understanding of file structures - Excellent verbal and written communication skills - Ability to compose professional documents, including letters and meeting minutes - Strong organizational skills with attention to detail - Ability to handle multiple tasks simultaneously and work independently - Self-motivated, with strong problem-solving skills - Team-oriented with a collaborative focus - Knowledge of state and federal regulations related to hospital credentialing - Knowledge of NCQA standards - Accurate typing skills Benefits Froedtert Health offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following: - Paid time off - Growth opportunity - Career Pathways & Career Tuition Assistance, CEU opportunities - Academic Partnership with the Medical College of Wisconsin - Referral bonuses - Retirement plan - 403b - Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics - Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work-life benefits available

Related Categories

Related Job Pages

More Claims Specialist Jobs

Full TimeRemoteTeam 10,001+Since 1931H1B Sponsor

• The Investigative Specialist reviews complex and often unique claims to assess their validity and ensure accurate outcomes. • In this role, you will investigate and verify the facts of loss for a range of automobile claims, from basic to advanced scenarios. • Leveraging your auto claims adjusting experience, you will evaluate coverage, determine liability, and assess damages. • You will also take ownership of the claims process by making informed decisions and effectively negotiating settlements. • Every claim presents a new challenge.

Illinois + 3 moreAll locations: Illinois | Nevada | Minnesota | Washington
$50K - $74.4K / year
Job Closed
Horace Mann logo

Auto Claims Adjuster I

Horace Mann

We're here for all school employees! Helping them live better and retire happier.

Full TimeRemoteTeam 1,001-5,000Since 1945H1B Sponsor

• Investigate auto claims and determine coverage and liability. • Evaluate damages and work toward fair and timely claim resolutions. • Collaborate with customers, repair facilities, and business partners. • Negotiate fair claim settlements while adhering to company best practices.

United States
$24 - $33 / hour
Job Closed
New England Life Care logo

A/R Specialist

New England Life Care

Collaborating to transform the patient care continuum

Full TimeRemoteTeam 201-500Since 1987H1B Sponsor

Role Description The Accounts Receivable Specialist is a REMOTE POSITION and is responsible for the follow-up, collections, and recovery of problematic accounts due from health insurance payers. The normal schedule will be Monday - Friday from 8:00am until 4:30pm. - Achieve performance appraisals with "meets expectations" or better - Demonstrate independence and competence to work basic denials - Demonstrate independence and competence in payer requirements for basic appeals - Demonstrate independence and competence and ability in submitting correct claims for payers - Demonstrate independence and competence in refund processing - Demonstrate independence and competence and ability to teach how to check claim status via phone or website - Demonstrate ability to complete on average 20 accounts per day - Demonstrate ability to work accounts timely within 2 weeks of receiving denial or needing follow up - Maintain audit percentage of 98% - Follow NELC policies and procedures in the normal conduction of company business - Assure that professional practice complies with state and federal regulations including HIPAA Privacy and Security regulations - Ensure that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations - Effectively communicate both verbally & in writing inside and outside the organization - Take the initiative to meet internal and external customer needs in a timely and courteous manner - Establish and maintain good working relationships - Display good judgment and take initiative - Complete appropriate amount of work in a timely manner without jeopardizing quality Qualifications - A minimum of 3 years’ experience with third party health insurance claims office or plan administrator involved in processing health provider claims required - A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required - Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred - Working knowledge of Home Infusion Therapy billing & collection preferred - Practical experience with Medicare; Medicaid; and third-party payer contracts Requirements - Associates Degree or bachelor’s degree in Business Administration preferred - Knowledge of HIPAA Privacy and Security requirements - Working knowledge of federal/state fraud and abuse laws required Benefits - Remote / Hybrid Position - Career Ladders - Health Insurance - Dental insurance - Vision insurance - Generous employer-matched 403b savings program - Company paid: Life insurance, Short- and long-term disability insurance - Paid time off - And much more!

United States
$21 - $23 / hour
Priority Technology Holdings, LLC logo

Supplier Enablement Specialist

Priority Technology Holdings, LLC

Join our team at Priority Technology Holdings, Inc. and be part of a dynamic and innovative company that is transforming the financial technology landscape. Together, we can shape the future of payments and banking solutions while providing unmatched value to our clients.

Role Description As a Supplier Enablement Specialist, you will partner with Organizations to make it simple for Suppliers to migrate to electronic payments. These payment platforms allow Organizations to streamline their accounts payable process and improve visibility by gaining greater control over payments. You will be responsible for driving supplier acceptance for financial institutions, working directly with various sales channels to achieve results as outlined by the organization. - Educate Vendors on products and deliver compelling value. - Build strong rapport and maintain ongoing relationships. - Maintain a high level of integrity. - Possess strong analytical, decision-making and closing skills. - Coordinate all internal resources necessary to facilitate each sale and execute proper account set-up. - Maintain above average performance ratings in key metric areas. Qualifications - Ability to articulate the value and close the sale of financial products. - 1 or more years of professional experience. - Strong communication, organizational and customer service skills. - Detail Oriented. - Effective consultative sales abilities. - Ability to ask for and close the sale. - Excellent time management skills. - Maturity to work within and contribute to an expanding organization. - Ability to work efficiently in a fast paced environment and make 70+ outbound calls per day while achieving sales goals. - Excellent rapport building and communication skills with a diverse group of clients, customers and management at all levels. - Excellent verbal and writing skills. - Great Customer Service acumen. Requirements - Provides fast, friendly, and accurate responses to customer inquiries. - Understands the company’s products, services, and systems inside and out. - Accurately explains features, policies, and troubleshooting steps. - Low error rates in responses or case handling. - Handles even difficult customers with calm and professionalism. Benefits - Compensation range: $19/hr-$20/hr - Financial Wellness: - Bonus programs - Financial wellness resources and employee discount programs - Health & Well-being: - Medical, dental, and vision coverage - Mental health support for employees and dependents through Lyra Health - Family planning and women’s health benefits through Carrot - Gym membership reimbursement and virtual wellness programs (including yoga) - Time Off: - 3 weeks PTO to start, with unlimited PTO after year one - Growth & Development: - Education expense reimbursement - Leadership development programs - Certified Payments Professional (CPP) certification support Company Description Join our team at Priority Technology Holdings, Inc. and be part of a dynamic and innovative company that is transforming the financial technology landscape. Together, we can shape the future of payments and banking solutions while providing unmatched value to our clients.

United States
$19 - $20 / hour