Credentialing Specialist (Green Bay, WI or Spokane, WA)

About the position

The Credentialing Specialist is responsible for all credentialing activities and initial analysis of new contracts. This role involves oversight of credentialing activities, including the completion and submission of applications, and following up with providers and payors on incomplete items. The specialist will work with payors to add new locations to existing contracts and maintain good working relationships with payor contacts. Additionally, the specialist will perform initial reviews of new payor contracts and suggest changes to discuss with the Director. Acting as a credentialing resource for providers, the specialist ensures that department operations are performed accurately and timely, identifies process improvement goals, and develops partnerships across departments to support business objectives.

Responsibilities
• Oversight of all credentialing activities including application completion and submission.
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• Follow up with providers and payors on incomplete items.
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• Work with payors to add new locations to existing contracts.
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• Maintain good working relationships with payor contacts.
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• Perform initial review of new payor contracts and suggest changes to discuss with Director.
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• Act as a credentialing resource for providers.
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• Ensure department operations are performed accurately and timely.
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• Identify and suggest process improvement goals to support operations.
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• Develop and maintain partnerships across all other departments, partners, and vendors.

Requirements
• At least a Bachelor's Degree in a healthcare or business related discipline, or equivalent experience.
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• At least three years of medical insurance, billing or claims experience, preferably in a supervisory capacity.
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• Strong knowledge of HIPAA privacy and security rules and regulations.

Nice-to-haves
• Certification in a relevant field is a plus.
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• Previous management level experience preferred.

Benefits
• Medical and dental insurance
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• Employer-matched 401(k)
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• Paid time-off
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• Paid travel
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• Short-term disability
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• Competitive wages

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