Credentialing and Reimbursement Specialist

The Credentialing & Reimbursement Specialist is responsible for coordinating, monitoring, and maintaining provider enrollment, re-enrollment, revalidation, and ERA/EFT processes in a timely and compliant manner.

Essential Duties And Responsibilities

- Coordinate TMHP and Medicare (MCR) revalidation processes, ensuring accuracy and compliance with deadlines 

- Set up payor sites for eligibility, claim filing, claim status, ERA, EFT, and appeals 

- Establish and maintain group accounts for multi-providers 

- Maintain and update provider licenses and insurance addresses  

- Prepare enrollment applications for all health plans, including Medicare and Medicaid

- Complete and distribute W-9 forms

- Demonstrate problem-solving and customer service skills  

- Ability to understand, analyze, and interpret complex documents 

- Other job-related duties as assigned

Knowledge And Experience

- High school diploma/GED required 

- Minimum of 2 years of provider enrollment experience preferred, including TMHP and Medicare revalidation.  

- Ability to distinguish and explain an EFT, ERA, EOB, COB, and “pay to” address   

- Ability to read and understand payor applications and how payors work 

- Knowledge of federal and state insurance laws and their interpretation as appropriate

- Knowledge of insurance claim processing, third-party reimbursement, and revalidation processes  

- Ability to work within a deadline-intense environment prioritizing workflow as needed.  

- Must be able to communicate clearly and professionally, verbally and in writing.

Emergicon requires satisfactory pre-employment drug screenings and background check.