Job Summary

The Credentialing Specialist (CS) supports our pediatric practice clients by enrolling their new providers with payors, and our billing team by serving as an internal resource for all credentialing-related billing matters.

Responsibilities

• Manage payor enrollment for new providers with new and established clients
• Ensure that each new provider’s CAQH is complete
• Actively communicate with all stakeholders on the status of the credentialing/enrollment process
• Maintain professional relationships with all payors or IPAs to ensure that credentialing is completed within a timely manner
• Field questions about contracts and credentialing and how they relate to billing
• Stay current with industry changes and update Account Managers accordingly through communication and training
• Work closely with Account Managers and billing team for credential-related denials and issues
• Provide assistance with other assigned tasks when/as workload permits

Qualifications

• 4 years of combined experience in relevant healthcare administration (credentialing, billing, compliance); at least 2 of these years specifically in payor enrollment.
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures and documentation
• Ability to research and and stay current with credentialing requirements with each payor
• Ability to use independent judgment, and to manage and communicate confidential information
• Demonstrated comfort with computer technology
• Established proficiency in or ability to quickly become proficient in the Google Workspace (G-Suite): Gmail, Google Drive, Docs, Sheets, etc.
• Demonstrated ability to prioritize, organize and track time-sensitive projects
• Strong attention to detail, organization and follow through

Ideal Characteristics

• Self-motivated and eager to learn
• Ability to prioritize and multitask
• Works with a blend of quality, speed, and accuracy
• Thrives in an autonomous work situation
• Prior remote work experience 

Remote & Hybrid Employment, Requirements

The position is available fully remote for candidates who live beyond a reasonable commuting distance from our office in Winooski, VT.  Local Vermont candidates are invited to apply for a hybrid position (3 days in office, 2 days remote).

• A private, dedicated space to ensure HIPAA compliance
• Sufficiently high speed and reliable internet service to perform the job. Download speed: optimal 10-20 mbps. Upload speed: over 5 mbps. Latency: under 50 is ideal. (Anything above 100 ms will not work.) A speed test for these metrics is available at https://speedof.me/

Benefits

• Health, vision, dental insurance, and short-term disability
• CTO accrued from the 1st day of employment, beginning with 2 weeks
• 6 paid holidays with 5 additional paid days 
• 3 paid days for personal emergency
• Paid time off for volunteer community service
• Paid parental leave
• Employee retirement account with 3% matching
• Employee Assistance Program

PedsOne is an E-Verify employer