The Credentialing Specialist manages end-to-end provider credentialing, enrollment, and re-credentialing processes while ensuring compliance with NCQA standards. They are responsible for maintaining data integrity, conducting quality assurance on files, and collaborating with operations teams to streamline workflows.
You will build and maintain the company's data infrastructure, including pipelines, models, and self-service analytics tools. Additionally, you will lead high-priority investigations to turn complex data into actionable business recommendations.
The Coding Specialist is responsible for assigning accurate CPT, ICD-10, and HCPCS codes to clinical documentation to ensure compliance and optimize reimbursement. They also serve as a subject matter expert, performing coding audits and supporting the RCM team with appeals and process improvements.
Manage the full billing lifecycle from eligibility verification to collections and denial management. Provide direct support to partners and patients while identifying trends to improve reimbursement and reduce A/R.
