Credentialing/Payor Enrollment Specialist- Cherry Hill NJ
Summary
Process healthcare provider credentialing and payor enrollment applications to secure coverage and resolve billing issues for PATHS' clients.
Job
Title: Credentialing/Payor Enrollment Specialist
Department: Credentialing
Reports To: Manager of Credentialing
Work Schedule: Monday-Friday 8AM-4:30PM
Job Summary
The Credentialing/Payor Enrollment Specialist supports PATHS’ mission by assisting patients and families in securing appropriate health coverage, resolving billing issues, and advocating for financial resources. This role ensures accurate documentation, compliance with HIPAA and healthcare regulations, and contributes to timely revenue recovery for PATHS’ provider clients across multiple states.
Essential Duties & Responsibilities
· Submitting initial and re-credentialing payor enrollment application for Medicare and Medicaid enrollment.
· Submitting initial and re-credentialing payor enrollment applications for commercial enrollment.
· Follow up and check status of submitted applications with payors.
· Track and follow-up to obtain provider ID numbers and effective dates.
· Develop working knowledge of payors enrollment process for multiple states.
· Serve as a liaison between billing department and the payors on troubleshooting claims denials due to provider enrollment issues.
· Maintain matrix of all facility and provider expiring credentials needed for provider enrollment.
· Maintain high level of organization while being extremely focused on details.
· Performs other related duties as assigned. *
Supervisory Responsibilities
This position has no supervisory responsibilities.