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Join a pioneering healthcare organization dedicated to ensuring seamless access to vital health services. We are at the forefront of patient care, committed to navigating the complexities of healthcare administration to support our extensive network of providers and ultimately improve patient outcomes across the nation. Are you ready to make a tangible impact in the healthcare sector? We are seeking a meticulous and proactive individual to join our dedicated team. In this pivotal role, you will be instrumental in ensuring our healthcare providers are properly enrolled with government and commercial payers, directly contributing to our operational efficiency and the continuous delivery of patient care. Your expertise will directly influence our ability to minimize administrative hurdles, resolve critical claims issues, and uphold compliance standards, ensuring our organization remains a trusted partner in health.
Job Responsibility:
Manage the timely and accurate processing of initial and revalidation applications for healthcare providers with various payers
Conduct quality control for individual enrollment applications submitted for government and commercial programs
Resolve claims issues for individual payers within our billing systems
Research, complete, and maintain compliance with individual government payers through credentialing, re-credentialing, and audit processes
Liaise with providers to obtain necessary signatures and validate information upon receipt of revalidation notices
Minimize denials and deactivation of government applications to reduce key metrics such as days sales outstanding (DSO), cost to collect, aged claims, and bad debt
Update credentialing and billing systems with provider information as received from government and commercial payers
Ensure organizational compliance with statutory requirements for government and commercial enrollment for healthcare providers
Collaborate effectively with internal teams and external vendors, building strong partnerships
Interface directly with providers and various operational teams (e.g., Credentialing, Accounts Receivable, Billing, Call Center) to ensure process integration
Develop provider-level reporting to ensure compliance criteria are met for government and commercial enrollment
Manage mail-based documentation and workflows efficiently
Requirements:
Be authorized to work in the United States
Not require sponsorship of any kind for the duration of the assignment
Be able to work on a W-2 basis
Verifiable High School Diploma or GED
Demonstrated experience with Microsoft Excel
Strong communication and organizational skills
Reliable and consistent attendance
Nice to have:
1-2 years of experience with government payers (e.g., Medicare, Medicaid)
Experience with commercial payers
Insurance experience
Willingness to learn and adapt in a dynamic environment
Ability to work collaboratively in a team environment