Credentialing Specialist (Payer Enrollment)

Lumexa Imaging is one of the country's largest providers of outpatient medical imaging. With over 5,000 team members and more than 185 outpatient imaging centers across 13 states, our team conducts more than 4 million outpatient studies annually. We are the partner of choice for health systems and radiologists, delivering best-in-class clinical excellence, operations, and state-of-the-art technology across our platform.

The Provider Enrollment Specialist is responsible for enrolling healthcare providers with commercial insurance payers, Medicare, and Medicaid to ensure timely reimbursement for services rendered. This role manages the end-to-end application process, monitors credentialing status, and resolves enrollment-related issues. Success in this role requires strong attention to detail, knowledge of healthcare regulations, and effective communication skills to collaborate with providers and payer representatives.

Essential Duties and Responsibilities

• Application Management:
  Prepare, submit, and track provider enrollment applications, re-credentialing packets, and demographic updates with commercial and government payers in a timely manner.
• Payer Follow-Up:
  Proactively communicate with insurance representatives to monitor application status, resolve processing issues, and reduce approval turnaround times.
• Database Maintenance:
  Accurately maintain and audit provider data within credentialing systems and databases such as CAQH, PECOS, and NPPES.
• Cross-Functional Collaboration:
  Work closely with billing, credentialing, and HR teams to ensure alignment and accuracy of provider information across all internal systems and platforms.
• Denial Resolution:
  Investigate and resolve claim denials, rejections, or payment delays resulting from enrollment discrepancies, provider data issues, or taxonomy errors.

Required Experience

• Minimum of 2 years of payer enrollment and provider credentialing experience in a healthcare setting.

Knowledge, Skills, and Abilities

• Strong understanding of provider credentialing and payer enrollment processes.
• CAQH experience is required
• Familiarity with provider identifiers, including NPI (National Provider Identifier) and TIN (Tax Identification Number).
• Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Strong verbal and written communication skills.
• High level of accuracy and attention to detail.
• Ability to build and maintain effective working relationships with providers, internal teams, and external payer contacts.
• Proficiency in Microsoft Office applications (Word, Excel, and Access) and credentialing software platforms.
• Experience with MD Staff or similar credentialing software is preferred.

Lumexa Imaging provides a competitive compensation program to attract, retain, and motivate a high-performance workforce.
 

Lumexa Imaging is an equal opportunity employer.