Job Details

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.

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.

Emergicon requires satisfactory pre-employment drug screenings and background check.

EMERGICON LLC is an EEO employer - M/F/Vets/Disabled