About the role
- The AR Credentialing Specialist is responsible for managing provider enrollment and credentialing processes with insurance payers to ensure accurate and timely reimbursements. The role involves close coordination with providers, insurance carriers, and internal teams to maintain up-to-date credentials and minimize claim denials related to credentialing issues.
- Handle end-to-end provider credentialing and re-credentialing with insurance companies.
- Maintain and update provider data in internal systems and payer portals.
- Verify provider information such as NPI, CAQH, state license, DEA, and malpractice insurance.
- Track credentialing applications and follow up with payers for approval status.
- Collaborate with the AR (Accounts Receivable) team to resolve denials or payment issues due to credentialing delays.
- Maintain documentation of all credentialing activities and ensure compliance with payer requirements.
- Communicate with providers and internal teams regarding status updates and missing documentation.
- Support the revenue cycle by ensuring providers are active and eligible with payers for billing.
- Bachelor’s degree (preferred) or equivalent experience in healthcare administration or related field.
- 1– 4 years of experience in AR, credentialing and enrollment within US healthcare.