Credentialing Specialist

Credentialing SpecialistRemote - Capitol Billing Group - Metairie, LA 70006Position Type: Full Time Job Shift: Day Category: Health CareCapitol 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 ResponsibilitiesReimbursement Strategy and Denial PreventionTake charge of the overall strategy to cut down on insurance denials and write-offs from payersIdentify, analyze, and prioritize root causes of denials and non-payment across modalities, payers, and sitesDesign and implement systematic solutions to prevent recurrenceIdentify denial trends and turn them into actionable operational SOP'sConduct follow up with payers and insurance companies to resolve claim denials and payment discrepanciesInvestigate and resolve issues causing delays in payment or reimbursement, ensuring accurate claims processingAssist in the identification of recurring denial patterns and recommend process improvement to reduce AR delaysMonitor and track outstanding accounts receivable (AR)Credentialing/Payer EnrollmentCollect, verify, and maintain facility/provider credentialsPrepare and submit initial and re-credentialing applications in accordance with organizational, payor, and regulatory requirementsMaintain accurate and complete electronic credentialing filesTrack credential expiration dates and proactively manage renewals to prevent lapsesComplete and submit provider enrollment applications for Medicare, Medicaid, and commercial payorsManage enrollments using CAQH, PECOS, NPPES, and payor-specific portalsConduct regular follow-ups with payors to resolve delays, missing documentation, or application deficienciesConfirm provider participation status and effective dates with each payorMaintain up to date fee schedulesMaintenance & ComplianceUpdate payors with changes to provider demographics, locations, group affiliations, and tax informationEnsure ongoing compliance with federal, state, and payor requirementsMaintain documentation for audits and internal reviewsPartner with billing, revenue cycle, and leadership teams to resolve credentialing- or enrollment-related claim issuesRemote Work ExpectationsMaintain reliable internet access and a secure, HIPAA-compliant remote work environmentCommunicate effectively with internal teams via email, phone, and virtual meetingsManage workload independently while meeting deadlines and productivity expectationsQualificationsExpertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics5+ year of experience in provider credentialing payor enrollment and denial managementStrong knowledge of Medicare, Medicaid, and commercial insurance enrollment processesProven success reducing denials and write-offs.Ability to manage multiple providers and deadlines independently in a remote settingExcellent written and verbal communication skillsSkills & CompetenciesHighly detail-oriented and deadline-drivenComfortable with frequent follow-ups and documentation tracking, particularly in ARProficient with Microsoft Office and web-based systemsSelf-motivated and able to work independently in a remote environmentAlways maintains confidentiality and professionalism