Payor Credentialing Specialist

Payor Credentialing Specialist

Company Overview

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team

Theoria's FinanceDepartment is seeking individuals to join its team to support its expansion and assist with the credentialing and enrollment of its medical staff with health plans.

Shift Structure

• Monday-Friday 9AM to 5PM EST
• Remote

Employment Type

• Full Time, Exempt

Essential Functions and Responsibilities

• Maintain accurate and up to date provider profiles on CAQH, PECOS, NPPES, and in our credentialing database.
• Process new providers and facilities within the enrollment system and the billing system
• Manage and audit provider tasks within the credentialing system (Medallion)
• Liaise between providers and enrollment staff to obtain all necessary documentation required for enrollment applications
• Process Provider, Facility and Location Enrollment with Medicaid, Commercial and 3rd party Networks.
• Maintaining CAQH and NPPES registries
• Serve as liaison with billers and other departments for payer coordination.
• Process Insurance company enrollment for clinicians
• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain an internal provider grid to ensure all information is accurate and logins are available.
• Complete credentialing, re-credentialing, and privileging applications to add providers to commercial payers, Medicare, and Medicaid.
• Manages the communication with the Medicaid, Medicare commercial insurance plan, or related program.
• Manages turn-around times/response times.
• Ensures providers have current and complete CAQH and provider enrollment applications.
• Assists providers through the processes as needed.
• Enrolls, revalidates, and terms providers with government and commercial payers.
• Other duties as assigned by leadership.

Requirements and Qualifications

• Minimum of 3 years of US Healthcare credentialing experience is a requirement.
• Bachelor's Degree
• Excellent communication skills, both verbal and written.
• Detail oriented

Physical Requirements

• Must be punctual or on time and adhere to the company's Time and Attendance policy.
• Must be able to remain sitting for the majority of their shift.

Compensation and Benefits

• PTO and holiday
• 401k with employer match
• Health insurance
• Employer Paid - Life Insurance Policy

Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.

#LI-SM1

#LI-Remote

#IND-GH