Credentialing Specialist (50608)

Job DetailsJob Location: Remote - Capitol Billing Group - Metairie, LA 70006Position Type: Full TimeJob Shift: DayJob Category: Health Care    Job Summary  Capitol Imaging Services, we’re a leading provider of diagnostic imaging services committed to delivering high-quality patient care through innovation and a compassionate approach. Our high-quality radiology services include—MRI, CT, PET/CT, Nuclear Medicine, ultrasound, X-ray, and mammography.  We are currently operating 60 facilities across six states in the Gulf Coast region.   The Credentialing & Payor Enrollment Specialist/Denial Management Specialist is responsible for ensuring our facility and healthcare providers at our outpatient facilities are properly credentialed and enrolled with government and commercial insurance payors. This fully remote role supports provider onboarding, maintains regulatory and payor compliance, and plays a critical role in ensuring uninterrupted patient access to care and timely reimbursement. The successful candidate will be accountable for reducing insurance denials, minimizing revenue write-offs, improving net reimbursement, and preventing future reimbursement failures through root-cause analysis and durable process improvement.  Key Responsibilities  Reimbursement Strategy and Denial Prevention  Take charge of the overall strategy to cut down on insurance denials and write-offs from payers  Identify, analyze, and prioritize root causes of denials and non-payment across modalities, payers, and sites  Design and implement systematic solutions to prevent recurrence  Identify denial trends and turn them into actionable operational SOP’s  Conduct follow up with payers and insurance companies to resolve claim denials and payment discrepancies  Investigate and resolve issues causing delays in payment or reimbursement, ensuring accurate claims processing  Assist i the identification of recurring denial patterns and recommend process improvement to reduce AR delays  Monitor and track outstanding accounts receivable (AR)  Credentialing/Payer Enrollment  Collect, verify, and maintain facility/provider credentials   Prepare and submit initial and re-credentialing applications in accordance with organizational, payor, and regulatory requirements  Maintain accurate and complete electronic credentialing files  Track credential expiration dates and proactively manage renewals to prevent lapses  Complete and submit provider enrollment applications for Medicare, Medicaid, and commercial payors  Manage enrollments using CAQH, PECOS, NPPES, and payor-specific portals  Conduct regular follow-ups with payors to resolve delays, missing documentation, or application deficiencies  Confirm provider participation status and effective dates with each payor  Maintain up to date fee schedules  Maintenance & Compliance  Update payors with changes to provider demographics, locations, group affiliations, and tax information  Ensure ongoing compliance with federal, state, and payor requirements  Maintain documentation for audits and internal reviews  Partner with billing, revenue cycle, and leadership teams to resolve credentialing- or enrollment-related claim issues  Remote Work Expectations  Maintain reliable internet access and a secure, HIPAA-compliant remote work environment  Communicate effectively with internal teams via email, phone, and virtual meetings  Manage workload independently while meeting deadlines and productivity expectations  Qualifications  Required  Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics  5+ year of experience in provider credentialing payor enrollment and denial management  Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes  Proven success reducing denials and write-offs.   Ability to manage multiple providers and deadlines independently in a remote setting  Excellent written and verbal communication skills    Skills & Competencies  Highly detail-oriented and deadline-driven  Comfortable with frequent follow-ups and documentation tracking, particularly in AR  Proficient with Microsoft Office and web-based systems  Self-motivated and able to work independently in a remote environment  Always maintains confidentiality and professionalism  Qualifications