Payor Credentialing Specialist

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⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $21 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Echo AI (acquired by Calabrio)

WebsiteLinkedInAll Job Openings

51 - 200 employees

🤖 Artificial Intelligence

☁️ SaaS

🤝 B2B

💰 $25M Series B on 2021-05

Artificial Intelligence • SaaS • B2B

Echo AI is a company that developed conversational AI and interaction-analytics tools for contact centers, focusing on speech-to-text, conversation intelligence, sentiment analysis, automated QA, and agent-assist features to boost agent productivity and customer experience. Its solutions were offered as cloud/SaaS products for enterprise contact centers and B2B customers and have been integrated into Calabrio ONE following its acquisition by Calabrio.

📋 Description

• Coordinate the credentialing, recredentialing, and provider enrollment process for physicians, advanced practice providers, and allied health professionals. • Complete, review, and submit credentialing and enrollment applications to Medicare, Medicaid, commercial insurance carriers, and managed care organizations. • Monitor application status, follow up with payors, and resolve deficiencies to ensure timely provider enrollment. • Verify provider credentials, including licensure, education, training, certifications, work history, malpractice coverage, and other required documentation. • Maintain provider records in credentialing databases: MD Staff, CAQH, PECOS, NPPES, and other applicable systems, enabling tracking of credential expiration dates and maintenance of audit-ready files. • Coordinate with providers and internal departments to obtain required documentation and respond to requests from payors for additional information. • Research and resolve credentialing and enrollment issues affecting provider participation and reimbursement. • Generate credentialing reports, maintain enrollment status reports, and support internal and external audits. • Ensure compliance with federal and state regulations, accreditation standards, HIPAA, and organizational policies; communicate credentialing status updates to leadership and providers. • Participate in process improvement initiatives. • Willingness to work occasional nights and weekends with up to 25% of travel required.

🎯 Requirements

• High School or GED - Required • Bachelors Degree in Business, healthcare, or any related field of study. Equivalent years of experience (in addition to requirement) may be substituted for degree. (Preferred) • Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) by the National Association of Medical Staff Services (NAMSS) (Preferred) • Strong organization skills. Detail oriented. Ability to multi-task and prioritize. • Able to communicate in a professional manner both verbally and in writing. • Minimum of 3 years of experience in healthcare facility credentialing and physician credentialing. • Experience utilizing MD Staff Software

🏖️ Benefits

• Competitive compensation • Comprehensive medical, dental, and vision coverage • Generous Paid Time Off • Parental Leave benefits • Retirement benefits • Tuition reimbursement