Credentialing Specialist

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🔥 18 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Capitol Imaging Services

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

🤖 Artificial Intelligence

👥 B2C

Healthcare • Artificial Intelligence • B2C

Capitol Imaging Services is a network of outpatient medical imaging centers providing diagnostic and interventional imaging services across multiple states (primarily Alabama, Florida, Georgia, Louisiana, Mississippi, and Texas). The company offers a wide range of modalities including MRI (open and conventional), CT, PET/CT, nuclear medicine, mammography, ultrasound, X-ray, DEXA (bone density and body composition), echocardiography, fluoroscopy, neuroimaging and related neurological testing. CIS supports both patients and referring physicians via patient and physician portals, online bill payment, medical records/release processes, and emphasizes lowering out-of-pocket expenses, fast results, and convenient locations. The organization also lists services such as Medical Imaging Research Services and AI Imaging Evaluations.

📋 Description

• Take charge of the overall strategy to cut down on insurance denials and write-offs from payers • Identify, analyze, and prioritize root causes of denials and non-payment across modalities, payers, and sites • Design and implement systematic solutions to prevent recurrence • Identify denial trends and turn them into actionable operational SOP’s • Conduct follow up with payers and insurance companies to resolve claim denials and payment discrepancies • Investigate and resolve issues causing delays in payment or reimbursement, ensuring accurate claims processing • Assist in the identification of recurring denial patterns and recommend process improvement to reduce AR delays • Monitor and track outstanding accounts receivable (AR) • Collect, verify, and maintain facility/provider credentials • Prepare and submit initial and re-credentialing applications in accordance with organizational, payor, and regulatory requirements • Maintain accurate and complete electronic credentialing files • Track credential expiration dates and proactively manage renewals to prevent lapses • Complete and submit provider enrollment applications for Medicare, Medicaid, and commercial payors • Manage enrollments using CAQH, PECOS, NPPES, and payor-specific portals • Conduct regular follow-ups with payors to resolve delays, missing documentation, or application deficiencies • Confirm provider participation status and effective dates with each payor • Maintain up to date fee schedules • Update payors with changes to provider demographics, locations, group affiliations, and tax information • Ensure ongoing compliance with federal, state, and payor requirements • Maintain documentation for audits and internal reviews • Partner with billing, revenue cycle, and leadership teams to resolve credentialing- or enrollment-related claim issues

🎯 Requirements

• Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics • 5+ year of experience in provider credentialing payor enrollment and denial management • Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes • Proven success reducing denials and write-offs • Ability to manage multiple providers and deadlines independently in a remote setting • Excellent written and verbal communication skills • Highly detail-oriented and deadline-driven • Comfortable with frequent follow-ups and documentation tracking, particularly in AR • Proficient with Microsoft Office and web-based systems • Self-motivated and able to work independently in a remote environment • Always maintains confidentiality and professionalism.

🏖️ Benefits

• Remote Work Expectations: Maintain reliable internet access and a secure, HIPAA-compliant remote work environment • Communicate effectively with internal teams via email, phone, and virtual meetings • Manage workload independently while meeting deadlines and productivity expectations