Credentialing​/Payor Specialist

Job Details:

Job Location:

Remote
- Capitol Billing Group
- Metairie, LA, Position Type:
Full Time, Salary Range:
Undisclosed, Job Category:
Health Care,

Capitol Imaging Services, we’re a leading provider of diagnostic imaging services committed to delivering high-quality patient care through innovation and a compassionate approach. Our high-quality radiology services include MRI, CT, PET/CT, Nuclear Medicine, ultrasound, X-ray, and mammography. We are currently operating 60 facilities across six states in the Gulf Coast region.

• 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 i 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

• 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

• 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