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Credentialing Specialist

Job in OR Oregon - USA , 97468
Company: Change Healthcare
Full Time position
Listed on 2021-04-19
Job specializations:
  • Healthcare
    Medical Billing and Coding
Job Description & How to Apply Below
Location: Remote
Transforming the future of healthcare isn't something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.

Here at Change Healthcare, we're using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you're ready to embrace your passion and do what you love with a company that's committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.

Credentialing Specialist

Overview of Position

The Credentialing Specialist will complete/submit all necessary documents/applications to credential providers with respective insurance carriers and national entities; including, but not limited to CAQH and NPI Registry. They will maintain current credentialing processes for all insurance carriers. They will complete routine review of carrier policies and forms to ensure current and update documents are being utilized; frequency determined by insurance or national entity.

What will be my duties and responsibilities in this job?

* Enter and maintain system profiles/databases used for storing provider billing numbers

* Written and/or verbal follow-up of outstanding credentialing requests with client and/or insurances carriers

* Research/resolve accounts appearing on A/R reports related to credentialing matters, including pre/post billing edits

* Assists in identifying current/potential credentialing issues specific to outstanding receivable

* May participate in trainings/meetings with Payers, internal departments, offshore partners, Client contact(s) and TES Management, etc. to address trends in denials or unprocessed claims

* Presenting data to appropriate parties and partnering to develop resolutions

* Participates in daily production assignments that will continue to develop understanding and knowledge of processing guidelines and expectations of respective client(s) payer mix

* Assist in credentialing training/quality review process of domestic/offshore partners

* Training and Quality Assurance of other team members or the provider practice as needed.

* Assist in other duties as assigned

What are the requirements needed for this position?

* High School Diploma or equivalent

* 2-3 years of additional schooling/related work experience

* Must be computer literate

* Intermediate working knowledge of MS Excel, MS Word and MS Outlook, and Adobe

What other skills/experience would be helpful to have?

* 1 year of A/R follow up or previous credentialing experience preferred

* Strong written and oral communication skills

* Strong customer service experience

* Must maintain patient/client confidentiality

* Working knowledge of various insurance credentialing requirements by provider type and specialty

* Ability to work independently with minimal supervision; drives execution

* Can marshal resources to complete tasks and orchestrate multiple activities to accomplish goals

* Ability to solve difficult problems in a timely manner with efficient resolutions

* Ability to work with and communicate with individuals of varying disciplines.

* Represents the office/Organization in a positive manner; supports and encourages strong morale and spirit in his/her team; works well with others

* Can negotiate skillfully in tough situations; can win consensus without damaging relationships

What are the working conditions and physical requirements of this job?

* Employee is regularly required to sit, use hands to finger, handle, or feel objects, tools, or controls and talk or hear. Employee must occasionally lift and/or move up to 25 pounds

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https:// and the supplemental information at https://

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to (Please contact us using the "Apply for this Job Posting" box below) with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted  box will not be accepted.

Click here https:// to view our pay transparency nondiscrimination policy.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.
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