Capitol Imaging Services

Credentialing Specialist

• Take charge of the overall strategy to cut down on insurance denials and write-offs from payers
• Identify, analyze, and prioritize root causes of denials and non-payment across modalities, payers, and sites
• Design and implement systematic solutions to prevent recurrence
• Identify denial trends and turn them into actionable operational SOP’s
• Conduct follow up with payers and insurance companies to resolve claim denials and payment discrepancies
• Investigate and resolve issues causing delays in payment or reimbursement, ensuring accurate claims processing
• Assist in the identification of recurring denial patterns and recommend process improvement to reduce AR delays
• Monitor and track outstanding accounts receivable (AR)
• Collect, verify, and maintain facility/provider credentials
• Prepare and submit initial and re-credentialing applications in accordance with organizational, payor, and regulatory requirements
• Maintain accurate and complete electronic credentialing files
• Track credential expiration dates and proactively manage renewals to prevent lapses
• Complete and submit provider enrollment applications for Medicare, Medicaid, and commercial payors
• Manage enrollments using CAQH, PECOS, NPPES, and payor-specific portals
• Conduct regular follow-ups with payors to resolve delays, missing documentation, or application deficiencies
• Confirm provider participation status and effective dates with each payor
• Maintain up to date fee schedules
• Update payors with changes to provider demographics, locations, group affiliations, and tax information
• Ensure ongoing compliance with federal, state, and payor requirements
• Maintain documentation for audits and internal reviews
• Partner with billing, revenue cycle, and leadership teams to resolve credentialing- or enrollment-related claim issues