Radiology Payor Credentialing Specialist at PBS Radiology Business Experts

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Full Time

Start Date

Immediate

Expiry Date

18 Mar, 26

Salary

0.0

Posted On

18 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing Knowledge, Organizational Skills, Leadership Skills, Research Skills, Independence, Communication Skills, Provider Data Management, Enrollment Management, Claims Processing, Project Management, Attention to Detail, Problem Solving, Time Management, EFT Enrollment, Demographic Updates, Portal Management

Industry

Hospitals and Health Care

Description

Job Details Level: Experienced Position Type: Credentialing Specilalist Education Level: High School Graduate or Equivelant Travel Percentage: No Travel Job Shift: Monday thru Friday Job Category: Health Care Radiology Payor Credentialing Specialist The Credentialing Specialist works with a high degree of independence and requires minimal training or supervision. They are responsible for managing all aspects of provider and group enrollment with insurance payors to ensure accurate claims submission and revenue collection. Essential Functions/Primary Job Duties Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Essential job functions are the fundamental duties of a position: the things a person holding the job absolutely must be able to do with or without reasonable accommodation. Essential job functions are used to determine the rights of an employee with a disability under the Americans with Disabilities Act (ADA). This is a sedentary role, sitting and/or standing and working at a computer for a minimum of eight (8) hours per day as a full-time employee. Key Responsibilities Enrollment & Revenue Setup Handle provider and group enrollment, demographic updates, EDI/ERA connections, and EFT enrollment for clients. Provider Data Management Maintain provider records and documents, while tracking and meeting strict, often uncommunicated, deadlines. Applications & Credentialing Complete initial and recredentialing applications accurately with minimal errors, following payor-specific guidelines. Updates & Changes Process demographic or location updates for clients as needed. Portal Management Navigate online portals, obtain access, and manage user assignments or terminations. Other Duties Perform additional tasks as assigned by management. The Credentialing Specialist plays a critical role in ensuring providers and groups are accurately enrolled and maintained with insurance payors, enabling smooth claims processing and revenue collection. This position requires a high degree of independence, strong organizational skills, and excellent communication abilities. Must-Have Qualifications Credentialing Knowledge: Strong understanding of physician credentialing and payor enrollment processes across multiple states and insurance payors. Organizational & Leadership Skills: Excellent organizational abilities, including use of project/task management software; proven ability to prioritize responsibilities and achieve short- and long-term goals. Research & Independence: Skilled in efficient online research with the ability to work independently and with minimal supervision. Experience: Minimum of two years of relevant experience. Collaboration & Communication Qualifications

Responsibilities

The Credentialing Specialist is responsible for managing provider and group enrollment with insurance payors, ensuring accurate claims submission and revenue collection. This includes handling demographic updates, EDI/ERA connections, and maintaining provider records.