Credentialing Specialist

Summary

Join Savoy Life, a healthcare startup focused on improving senior living, as a part-time Credentialing and Billing Operations Specialist. This fully virtual role centers on owning the end-to-end credentialing and enrollment process for health plans and IPAs, starting from identifying contacts to monitoring application statuses. You will also ensure accurate and timely claim reimbursement by managing payer configurations and resolving billing discrepancies with the RCM vendor. Initially focusing on credentialing (up to 15 hours/week), this 1099 position offers potential for growth and conversion to a W2 role. The position requires extensive experience in healthcare provider credentialing and billing, along with knowledge of payer enrollment processes and relevant software. You will work independently, building structure from the ground up, and demonstrate strong attention to detail and problem-solving skills.

Requirements

• Extensive experience in healthcare provider credentialing & enrollment as well as at least light billing management
• Credentialing experience must extend beyond working at a health plan and must be comfortable starting the credentialing process from scratch
• Knowledge of payer enrollment processes, CAQH, NPPES, PECOS, and insurance verification
• Proficiency in Microsoft Office (Excel, Word, Outlook) and credentialing software

Responsibilities

• As Savoy enters new states, identify and prioritize health plans and IPA groups to reach out to as well as the processes to do so
• Manage and drive the initial credentialing and re-credentialing of healthcare providers with health plans and IPA groups (Medicare, Medicaid, Commercial plans, etc.) including identifying contacts to reach out to when barriers arise such as leveraging leadership’s LinkedIn contacts
• Prepare, review, and submit enrollment applications and supporting documentation to health plans and IPAs
• Track and follow up on application statuses to ensure timely approval
• Maintain and update provider credentialing files in accordance with regulations
• Communicate with insurance companies and the internal team to resolve credentialing and enrollment issues
• Collect, review, and validate credentials for our clinical team including licenses, certifications, and education
• Ensure compliance with federal, state, and payer-specific requirements
• Maintain a credentialing database ensuring all required documents are up to date and complete
• Setup and maintain Electronic Remittance Advice (ERA), Electronic Data Interchange (EDI), and eligibility verification connections within the EHR system
• Monitor and verify that claims are paid in accordance with contracted rates and credentialing setup for each payer and provider
• Coordinate with the RCM vendor to resolve discrepancies between credentialed status and actual reimbursement received as well as troubleshoot issues related to claim denials, eligibility rejections, or enrollment lapses
• Validate provider IDs, NPI numbers, and taxonomies are correctly configured in billing and EHR platforms
• Provide additional pockets of support such as managing Savoy’s accounts payable platform to approve and complete invoices (platform is very user friendly) and managing vendor contracts through an AI tool

Preferred Qualifications

• Comfortable working with little to no structure and building structure from the ground up (this is a startup, and this is the only role to support credentialing today) paired with clear expectations of outputs
• Ability and desire to learn and grow with a belief in the growth mindset
• Strong attention to detail, organizational, and communication skills
• Strengths with working proactively and problem solving independently before escalating support

Benefits

$25-$35/hour