The Credentialing & Reimbursement Specialist is responsible for coordinating, monitoring, and maintaining provider enrollment, re-enrollment, revalidation, and ERA/EFT processes in a timely and compliant manner.
This position reports directly to the Credentialing Assistant Manager and collaborates with Emergicon personnel across all departments.
ESSENTIAL DUTIES AND RESPONSIBILITIES
•Coordinate TMHP and Medicare (MCR) revalidation processes, ensuring accuracy and compliance with deadlines
•Set up payor sites for eligibility, claim filing, claim status, ERA, EFT, and appeals
•Establish and maintain group accounts for multi-providers
•Maintain and update provider licenses and insurance addresses
•Prepare enrollment applications for all health plans, including Medicare and Medicaid
•Complete and distribute W-9 forms
•Demonstrate problem-solving and customer service skills
•Ability to understand, analyze, and interpret complex documents
•Other job-related duties as assigned
KNOWLEDGE AND EXPERIENCE
•High school diploma/GED required
•Minimum of 2 years of provider enrollment experience preferred, including TMHP and Medicare revalidation.
•Ability to distinguish and explain an EFT, ERA, EOB, COB, and “pay to” address
•Ability to read and understand payor applications and how payors work
•Knowledge of federal and state insurance laws and their interpretation as appropriate
•Knowledge of insurance claim processing, third-party reimbursement, and revalidation processes
•Ability to work within a deadline-intense environment prioritizing workflow as needed.
•Must be able to communicate clearly and professionally, verbally and in writing.