Credentialler - Skilled in payer portals, credentialing software, and MS Office (ZR_18017_JOB)

This is a remote position.

Key Responsibilities:

1. Credentialing
   

   • Manage and complete the credentialing process for providers and clinics with insurance companies.
     
   • Maintain and update provider and clinic information in payer systems and internal databases.
     
   • Ensure timely submission and follow-up of all required documents to meet payer deadlines.
     

2. Contracting
   

   • Facilitate the contracting process between the clinic and insurance payers.
     
   • Review and analyze contract terms to ensure alignment with clinic goals and compliance with regulations.
     
   • Negotiate terms, reimbursement rates, and other contract details to secure favorable agreements.
     

3. Payer Relations
   

   • Serve as the primary liaison between the clinic and insurance payers during the credentialing and contracting process.
     
   • Resolve issues and discrepancies promptly to avoid delays in network inclusion.
     
   • Build and maintain positive relationships with payer representatives.
     

4. Compliance and Record-Keeping
   

   • Ensure compliance with federal, state, and payer-specific guidelines throughout the credentialing and contracting process.
     
   • Maintain organized records of all applications, contracts, and correspondence.
     
   • Monitor and update credentialing and contract renewal timelines to prevent lapses.
     

5. Collaboration and Communication
   

   • Work closely with clinic leadership and other administrative staff to align credentialing and contracting activities with clinic objectives.
     
   • Provide regular updates on credentialing status and contracting progress.
     

Requirements

Qualifications:

• Experience: Minimum of  1-2 years in medical credentialing, contracting, or payer relations, preferably in a clinical setting.
  
• Skills:
  • Strong understanding of insurance credentialing and contracting processes.
    
  • Excellent negotiation and communication skills.
    
  • Proficient in managing multiple tasks and meeting deadlines.
    
  • Attention to detail and a high level of organization.
    
• Technical Proficiency: Familiarity with payer portals, credentialing software, and Microsoft Office Suite.