Credentialing Specialist

Capitol Imaging Services

Credentialing Specialist responsible for ensuring provider enrollment and cut down on insurance denials. Managing healthcare provider credentials and compliance in a fully remote environment.

Posted 7/28/2026full-timeRemote • Louisiana • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare credentialing and reimbursement processes, with a strong focus on reducing denials and managing provider enrollments. Proficient in maintaining compliance with regulatory requirements and managing accounts receivable effectively.

Highest-signal resume keywords

Healthcare CredentialingDenial ManagementProvider EnrollmentMedicare and Medicaid ProcessesAccounts Receivable Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Denial AnalysisClaims ProcessingSOP DevelopmentCredentialing ApplicationsRegulatory ComplianceProcess ImprovementDocumentation TrackingData AnalysisRoot Cause AnalysisPayment Reconciliation

Soft Skills

Excellent Communication SkillsDetail-OrientedDeadline-DrivenSelf-MotivatedProfessionalism

Tools & Technologies

Microsoft OfficeCAQHPECOSNPPESWeb-Based Systems

Industry Keywords

Insurance DenialsAccounts ReceivableCredentialingPayer RelationsHealthcare Compliance

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics
5+ year of experience in provider credentialing payor enrollment and denial management
Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes
Proven success reducing denials and write-offs
Ability to manage multiple providers and deadlines independently in a remote setting
Excellent written and verbal communication skills
Highly detail-oriented and deadline-driven
Comfortable with frequent follow-ups and documentation tracking, particularly in AR
Proficient with Microsoft Office and web-based systems
Self-motivated and able to work independently in a remote environment
Always maintains confidentiality and professionalism.

Benefits

Comp & perks

Remote Work Expectations: Maintain reliable internet access and a secure, HIPAA-compliant remote work environment
Communicate effectively with internal teams via email, phone, and virtual meetings
Manage workload independently while meeting deadlines and productivity expectations