Revenue Cycle Credentialing Specialist

Job not on LinkedIn

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $67.6k - $101.4k / year

⏰ Full Time

🟢 Junior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Exact Sciences

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1995

⚕️ Healthcare Insurance

🧬 Biotechnology

🔬 Science

Healthcare Insurance • Biotechnology • Science

Exact Sciences is a global leader dedicated to the fight against cancer. Headquartered in Madison, Wisconsin, Exact Sciences focuses on developing and marketing advanced cancer screening and diagnostic tests that help prevent cancer, detect it earlier, and guide treatment. The company is deeply committed to its mission of eradicating cancer and the suffering it causes, driven by values of innovation, integrity, teamwork, accountability, and quality. It fosters an inclusive culture and offers diverse teams opportunities to make a meaningful impact in the lives of individuals worldwide by advancing cancer detection technologies.

📋 Description

• Facilitate contract implementation by being proactive and reactive, with internal and external parties to ensure the public and private payer contract paperwork and credentialing is in alignment with corporate goals, contracts, and/or regulations. • Prepare and maintain credentialing files and reports for all payors and government entities. • Expand both government and commercial payor profiles to include all lines of business units due to mergers and acquisitions; complete updates required by contracts for credentialing, disclosure, and demographic information. • Process and file applications with third party payors according to each payor’s individual requirements and addresses discrepancies, as requested, by payors. • Conduct all follow up steps until payor approval, completion, and acceptance is obtained. • Update NPI records according to provider specifications. • Enroll provider in Medicare/Medicaid as prescribed by each program's requirements. • Track licensure, accreditation, and insurance certificate expiration dates to ensure timely processing to be compliant with mandates for contractual agreements with state and federal regulations with payors. • Complete requests for re-credentialing for payors, commercial, and government entities. • Accept and process all requests from payers for credentialing information, updates, and new contracts and assays. • Answer questions, inquiries, and process requests from all internal and external stakeholders related to credentialing information. • Enroll all business units in Medicare/Medicaid programs. • Address enrollment deficiencies and payor issues regarding commercial and government entities. • Assist with electronic funds transfer (EFT) and electronic data interchange (EDI) enrollment, tracking, and filing. • Serve as liaison between parent subsidiaries, third party billing agents, payors, commercial, Government entities, and all stakeholders to ensure revenue/reimbursement pull through. • Maintain historical data and files. • Interface with multiple departments to provide updates and stay abreast of current initiatives that could affect credentialing and enrollment. • Monitor incoming emails for Odxclaimsupport, Payor Credentialing, GovTeam, ManagedCareContracts, Contact ManagedCare, and CommercialOpsFax.

🎯 Requirements

• Associates degree in healthcare administration, public health, business administration, or related field; or high school degree/general education diploma and 2 years of relevant experience in lieu of Associates degree. • 1+ years of contracting experience within the healthcare industry. • Demonstrated knowledge of public and private Managed Care payers and reimbursement processes. • Demonstrated understanding of market-related issues, contract development, negotiation, and pull through, as well as the legal and regulatory implications associated with private and government payer contracting. • Basic knowledge of Microsoft Office; including Word, Excel, Access, Outlook, and PowerPoint. • Demonstrated ability to perform the Essential Duties of the position with or without accommodation. • Authorization to work in the United States without sponsorship.

🏖️ Benefits

• paid time off (including days for vacation, holidays, volunteering, and personal time) • paid leave for parents and caregivers • a retirement savings plan • wellness support • health benefits including medical, prescription drug, dental, and vision coverage