Credentialing Specialist

🔥 38 minutes ago

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $20 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Aspirion

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2006

💼 Consulting

📦 Logistics

🛡️ Insurance

💰 Series unknown on 2012-02

Consulting • Logistics • Insurance

Aspirion is a healthcare revenue cycle management company that helps hospitals recover revenue from denied and complex claims. The company deploys AI automation and a proprietary Compass platform, staffed with US-based attorneys, clinicians, and AI engineers, to overturn clinical denials, maximize out-of-network reimbursement, perform zero-balance reviews, and recover payment variances across services such as denials management, AR management, complex claims, motor vehicle accidents, workers' compensation, TRICARE, and out-of-state Medicaid. Aspirion emphasizes measurable recovery impact (over $6 billion captured), increased collections for clients, HITRUST certification, Best in KLAS awards, and partnerships with large health systems.

📋 Description

• Manage initial credentialing, recredentialing, and provider enrollment processes • Prepare, submit, and monitor credentialing applications to hospitals, health plans, government payers, and other credentialing entities • Maintain accurate and current provider information in credentialing databases • Track credential expirations, including licenses, certifications, DEA registrations, malpractice insurance, and other required documentation • Obtain renewal documentation proactively to prevent credentialing lapses • Monitor application status and follow up with payers and credentialing organizations • Maintain compliance with federal, state, payer, and organizational credentialing requirements • Conduct primary source verification according to accreditation and regulatory standards • Review provider files for completeness and accuracy before submission • Assist with provider enrollment, revalidation, and demographic updates with Medicare, Medicaid, and commercial insurance carriers • Respond to credentialing inquiries from providers, leadership, clients, and payer representatives • Prepare credentialing reports and provide status updates to leadership • Support audits and accreditation reviews by maintaining organized and compliant provider files • Collaborate with internal departments to resolve credentialing and enrollment issues affecting provider participation or reimbursement • Maintain confidentiality of sensitive provider and organizational information • Meet credentialing and enrollment timelines, maintain provider participation without lapses, ensure record accuracy, comply with requirements, and achieve service-level agreements and performance metrics

🎯 Requirements

• Strong understanding of credentialing, provider enrollment, and recredentialing processes • Knowledge of Medicare, Medicaid, and commercial payer requirements • Familiarity with CAQH, NPPES, PECOS, and payer enrollment portals • Excellent organizational skills with the ability to manage multiple deadlines simultaneously • Strong attention to detail and commitment to accuracy • Effective verbal and written communication skills • Ability to work independently and prioritize workload in a fast-paced environment • Proficiency with Microsoft Office Suite, including Excel, Word, and Outlook • Experience working with credentialing databases and provider management systems preferred • Strong problem-solving and follow-up skills • High school diploma or equivalent • Minimum of 2 years of credentialing, provider enrollment, healthcare administration, or related experience • Associate or bachelor's degree in healthcare administration, Business Administration, or a related field preferred • Certified Provider Credentialing Specialist (CPCS) designation or willingness to obtain certification • Experience credentialing providers across multiple states and payer networks • Experience within healthcare revenue cycle management, physician practice management, or healthcare consulting organizations • US remote-based colleagues are not permitted to work from a location outside of the United States, at any time, without prior, written approval

🏖️ Benefits

• Fully remote work arrangement • Opportunity to work alongside a talented and driven team • Engagement with innovative technology • Continuous growth and professional development environment