Credentialing and Health Insurance Specialist

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RightSite Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

📡 Telecommunications

Healthcare • Healthcare Insurance • Telecommunications

RightSite Health is changing how Emergency Medical Services (EMS) navigates non-emergent patient care. By partnering with EMS in-dispatch and on-scene, RightSite connects patients with Telehealth ER Doctors and provides patient navigation services. This innovative approach allows patients to access healthcare immediately without the need for a physical trip to the ER, improving overall care quality and efficiency while reducing costs. RightSite’s services include ongoing assistance with prescriptions, transport to appointments, and social services referrals to ensure continuous support for patients.

📋 Description

• Manage all aspects of the provider licensing and credentialing process, including health plan network participation across multiple states • Onboard new providers through IMLC, licensure, Medicare, Medicaid, and DEA processes • Maintain and verify provider information on CAQH, NPPES, PECOS, Availity, and other external sites • Manage provider renewals involving IMLC, licensure, and Nurse Compact requirements • Handle health plan applications, follow-up, contracting, and credentialing for fee-for-service arrangements • Maintain health plan credentialing requirements and specific training requirements • Manage databases, effective-date inputs, and passwords • Support billing partners with effective dates, passwords, and health plan issues • Develop policies and procedures for physician credentialing and contracting • Communicate with Operations to support provider scheduling • Optimize revenue cycles, ensure compliance with state and federal regulations, and contribute to the organization’s financial health

🎯 Requirements

• Bachelor’s degree in healthcare administration, business, or related field or equivalent work experience • Minimum 2 years of experience in provider onboarding • Proficiency in health plan networks • Strong knowledge of licensing, credentialing, Medicare, and Medicaid • Familiarity with HIPAA regulations and privacy standards • Comprehensive knowledge of provider licensure and credentialing across multiple states and provider types • Understanding of external regulatory systems, state and federal requirements, and regulatory compliance • Meticulous accuracy when handling provider information, licensure data, and records • Ability to analyze complex licensure issues, identify discrepancies, and develop effective solutions • Proficiency in clearly communicating complex licensure and credentialing issues to Operations • Strong aptitude for using and adapting to billing software, electronic health record systems, and data analysis tools

🏖️ Benefits

• The opportunity to be a part of a dynamic, mission-driven organization • Competitive base salary • Market-competitive healthcare coverage, including medical, dental, vision, life, and disability • The opportunity to work alongside talented and professional colleagues with the ability to grow