Payor Credentialing Specialist

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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

• Perform duties associated with payor enrollment, credentialing, re-credentialing, and privileging network providers. • 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 such as MD Staff, CAQH, PECOS, NPPES. • Coordinate with providers and internal departments to obtain required documentation and respond to requests from payors. • 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.

🎯 Requirements

• High School or GED - Required • Bachelor's Degree in Business, healthcare or related field of study - Preferred • Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) - Preferred • Strong organization skills, detail oriented, ability to multi-task and prioritize - Required • Minimum of 3 years of experience in healthcare facility credentialing and physician credentialing - Required • Experience utilizing MD Staff Software - Preferred

🏖️ Benefits

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