Insurance Processor
NightOwl Consulting
Medical Insurance Billing and Credentialing Specialist
Sourcefit
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇵🇭 Philippines
Visit company websiteJob Level
JuniorMid-Level
About the role
- Facilitate initial credentialing and re-credentialing processes for healthcare providers
- Prepare and submit credentialing applications and supporting documentation
- Track and follow up on submitted applications to ensure timely approval
- Verify credentials, education, training, licensure, and experience of healthcare providers
- Maintain and update credentialing database with accurate provider information
- Ensure all credentialing documents are current and stored securely
- Monitor and track expiration dates of licenses, certifications, and other credentials
- Ensure compliance with all regulatory and accrediting agency requirements
- Stay updated with changes in regulations and standards affecting credentialing
- Conduct regular audits of credentialing files to ensure completeness and accuracy
- Serve as a liaison between healthcare providers, insurance companies, and healthcare organizations
- Respond to inquiries from providers and payers regarding credentialing status
- Communicate effectively with providers regarding missing or expiring credentials
- Assist with License and DEA research and process
- Respond to any questions from providers in regards to licensing applications
- Communicate on license application progress
- Charges and payments data entry
- Obtain and document status of claims from insurance portals
- Assist with billing team projects
- Identify opportunities to streamline and improve processes
- Implement best practices to enhance efficiency and accuracy.
Requirements
- High school diploma or equivalent required
- Associate’s or Bachelor’s degree in healthcare administration, business, or a related field preferred
- Minimum of 2 years of experience in medical credentialing and or licensing
- Familiarity with insurance, billing and healthcare industry regulations
- Strong attention to detail and organizational skills
- Excellent written and verbal communication skills
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
- Ability to handle sensitive and confidential information with discretion
- Knowledge of credentialing software and databases is a plus
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred but not required.
Benefits
- Medical Insurance 📊 Resume Score Upload your resume to see if it passes auto-rejection tools used by recruiters Check Resume Score
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialinglicensingdata entryauditingbillingclaims managementregulatory complianceprocess improvementcredentialing softwareMicrosoft Office Suite
Soft skills
attention to detailorganizational skillswritten communicationverbal communicationdiscretionliaison skillsproblem-solvingtime managementinterpersonal skillscustomer service
Certifications
Certified Provider Credentialing Specialist (CPCS)Certified Professional Medical Services Management (CPMSM)