Metro Vein Centers logo
Metro Vein Centers

Specialized provider of minimally-invasive medical and cosmetic treatments for varicose veins and spider veins.

Credentialing Specialist

Claims SpecialistClaims SpecialistFull TimeRemoteMid LevelTeam 501-1,000Since 2008Company SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Credentialing Specialist

Metro Vein Centers

Role Description As a Credentialing Specialist at Metro Vein Centers, you are an integral team member to our continued growth. This role is responsible for provider credentialing, payer enrollment, and recredentialing to ensure clean participation, timely effective dates, and uninterrupted patient access and reimbursement. Reporting to the Supervisor of Credentialing, you’ll work daily in CAQH, payer portals (e.g., Availity), Medicare PECOS, and our credentialing database, collaborating closely with Recruitment, Clinical leadership, and RCM. The ideal candidate is detail-oriented, process-driven, and has experience in provider enrollment. This is a remote role; we’re looking for a self-starter with strong ownership and follow-through. What You’ll Do - Submit and track provider enrollments across Medicare/Medicaid (PECOS) and commercial payers (e.g., Availity) to secure effective dates. - Identify network expansion opportunities by enrolling providers into additional payer products, plans, and service locations. - Maintain CAQH attestations and accurate provider data across payer portals and internal credentialing systems. - Monitor re-validations/re-credentialing and manage expirables to prevent participation lapses. - Assist with onboarding new providers: gather documents, set up NPI/taxonomy/locations, and coordinate start-date readiness. - Respond to payer requests, supply additional documentation, and resolve application issues promptly. - Escalate concerns and complex cases to the Supervisor of Credentialing for timely resolution and participate in special projects as needed. Qualifications - 2+ years in provider credentialing and/or payer enrollment (physician group, MSO, health plan, or hospital). - Hands-on with CAQH (attestations/rosters), Medicare PECOS, and payer portals (e.g., Availity). - Working knowledge of Medicare/Medicaid and commercial enrollment rules. - Proficient in credentialing systems (e.g., MD-Staff/Cactus) and Excel/Google Sheets. - Strong data accuracy and documentation habits; able to maintain clean provider records across multiple systems. - Effective written/verbal communication with payers, providers, and internal stakeholders; escalates issues appropriately. - Proven ability to prioritize in a high-volume environment, meet deadlines, and follow SOPs with minimal supervision. - Self-starter mindset with ownership and follow-through in a remote setting. - High school diploma or equivalent required. Benefits - Medical, Dental, and Vision Insurance - 401(k) with Company Match - Paid Time Off (PTO) + Paid Company Holidays - Company-Paid Life Insurance - Short-Term Disability Insurance - Employee Assistance Program (EAP) - Career Growth & Development Opportunities

Related Categories

Related Job Pages

More Claims Specialist Jobs

Role Description As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statutes, policy provisions, and company guidelines. - Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature - Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) - Alert Supervisor and Special Investigations Unit to potentially suspect claims - Ensure timely denial or payment of benefits in accordance with jurisdictional requirements - Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure - Negotiate claims settlements with client approval - Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition - Work collaboratively with Lodestar nurse professionals to develop and execute return to work strategies - Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome - Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced - Demonstrate technical proficiency through timely, consistent execution of best claim practices - Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues - Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions - Authorize treatment based on the practiced protocols established by statute or the Lodestar Managed Care department - Assist Lodestar clients by suggesting panel provider information in accordance with applicable state statutes - Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work Qualifications - Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required - At least 3-5 years' experience handling lost time workers compensation claims required; past experience with PA jurisdiction is required - Associate in Claims (AIC) Designation or similar professional designation desired - Active license required or ability to obtain license within 90 days of employment in mandated states - Familiarity with medical terminology and/or Workers' Compensation - Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously

United States
USAA logo

Injury Examiner

USAA

Since 1922, USAA has offered a fully integrated array of financial services to active and former U.S. military members and their families. USAA's services inclu

Title: Injury Examiner Location Phoenix, Arizona; Colorado Springs, Colorado; San Antonio, Texas Job ID R0117304 Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Injury Examiner, you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy. This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site three days per week. What you'll do: - Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims. - Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes. - Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates. - Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation. - Partners and/or directs vendors and internal business partners to facilitate timely claims resolution. - Serves as a resource for team members on complex claims. - Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication. - Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. - Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: - High School Diploma or General Equivalency Diploma. - 4 years auto claims and injury adjusting experience. - Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations. - Advanced negotiation, investigation, communication, and conflict resolution skills. - Demonstrated strong time-management and decision-making skills. - Proven investigatory, prioritizing, multi-tasking, and problem-solving skills. - Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims. - Ability to exercise sound financial judgment and discretion in handling insurance claims. - Advanced knowledge of coverage evaluation, loss assessment, and loss reserving. - Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. What sets you apart: - 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage - College Degree (Bachelor’s or higher) - Insurance Designation - US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $85,040 - $162,550. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Arizona + 2 moreAll locations: Arizona | Colorado | Texas
$85.0K - $162.6K / year
USAA logo

Injury Examiner

USAA

Since 1922, USAA has offered a fully integrated array of financial services to active and former U.S. military members and their families. USAA's services inclu

Title: Injury Examiner Location: United States Type: Full-Time Job Description: Job ID: R0117304 At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Injury Examiner, you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy. This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site three days per week. What you'll do: - Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims. - Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes. - Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates. - Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation. - Partners and/or directs vendors and internal business partners to facilitate timely claims resolution. - Serves as a resource for team members on complex claims. - Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication. - Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. - Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: - High School Diploma or General Equivalency Diploma. - 4 years auto claims and injury adjusting experience. - Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations. - Advanced negotiation, investigation, communication, and conflict resolution skills. - Demonstrated strong time-management and decision-making skills. - Proven investigatory, prioritizing, multi-tasking, and problem-solving skills. - Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims. - Ability to exercise sound financial judgment and discretion in handling insurance claims. - Advanced knowledge of coverage evaluation, loss assessment, and loss reserving. - Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. What sets you apart: - 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage - College Degree (Bachelor’s or higher) - Insurance Designation - US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $85,040 - $162,550. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

United States
$85.0K - $162.6K / year

Records Management Specialist I , General Clerk

MPF Federal

MPF Federal, founded in 2012 and headquartered in Washington, DC, is a consulting firm specializing in federal contracting. The company provides services in cyb

Title: Records Management Specialist I (General Clerk) Location: College Park MD US Job Description: MPF Federal is bringing on a Records Management Specialist 1 (general clerk) to support the FDA's regulatory mission by keeping critical documents organized, accurate, and moving. You'll work onsite with FDA division personnel, handling the documents that keep regulatory reviews on track. This is steady, detail-driven work with clear processes, direct supervision, and room to build federal contracting experience. COMPENSATION: $18.00 per hour *This is a hybrid position with onsite work in College Park, MD* What You'll Do - Process, classify, and label FDA regulatory documents using multiple data entry systems - Perform data entry, scanning, filing, indexing, and file maintenance for physical and electronic records - Prepare acknowledgement letters, memorandums, forms, and standard reports - Open, process, and distribute incoming mail; create and affix barcode labels - Retrieve documents and information in response to user requests - Provide clerical and administrative support to project staff Requirements - High school diploma or equivalent plus 1 to 2 years of related administrative or data entry experience - Strong computer skills and the ability to perform data entry - Good organizational and interpersonal skills and a team-first attitude - Ability to lift and move standard boxes up to 30 lbs - Willingness to learn regulatory terminology and become the go-to person for your unit's files Benefits MPF Federal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We offer a competitive compensation package including a competitive salary, medical benefits, PTO, holiday pay and more.

Maryland
$0 / hour