Payor Credentialist, Full Time

Cabinet Peaks Medical Center is looking for a Payor Credentialist to join the Revenue Cycle Team!

The Payor Credentialist is responsible for facilitating the enrollment of all healthcare providers with commercial and government insurance networks (payers). This position ensures that all physicians, mid-level providers, and clinical staff are fully credentialed, contracted, and active within the required networks to guarantee seamless billing operations and uninterrupted revenue cycle performance.  Additionally maintaining up to date charge description master items.  Performing account review and resolving credit balance accounts.

Major Job Duties & Responsibilities

Prepare, submit, and track complex initial and recredentialing applications for both government (Medicare, Medicaid) and commercial insurance plans.

Update and maintain provider profiles on centralized industry databases, including the CAQH ProView portal, PECOS, and NPPES (NPI registry).

Authenticate all clinical provider credentials, including state medical licenses, DEA certificates, board certifications, educational background, and malpractice insurance coverage.

Proactively track and monitor expiration dates for all medical licenses, certifications, and insurance policies to ensure zero gaps in provider network participation.

Actively follow up with insurance payers on pending applications, successfully troubleshooting delays, credentialing denials, or network alignment issues.

Partner closely with the medical billing team to research and resolve credentialing-related claim denials or billing holds.

Enter and update all provider data within internal electronic medical records (EMR) or dedicated credentialing software systems to ensure enterprise-wide accuracy.

Process charge rejection in the current EMR software, this includes contacting departments and resolving outstanding charge entry items.

Updating the CDM with new codes, price increases/decreases, as approved through Fin Thrive and administration request.

Reviewing and updating Anesthesia waste

Works and actively collects on Client aging. Developing a strong working relationship with the clients, the CPMC OHS department.

Participates in necessary meetings related to credentialing, client/OHS billing, and CDM items across the revenue cycle and facility.

Maintains a professional “team player” attitude in all communications.

Reviews accounts with current credit balances and resolves the balance issuing a refund, initiating a pull back, submitting correction to adjustments, etc.

Other duties as assigned by supervisor/administration.

Skills, Knowledge, & Abilities

Ability to establish and maintain effective working relationships with patients, CPMC staff members, and the public.

Proficient computer skills including word processing and spreadsheet software; Meditech knowledge preferred.

Basic Knowledge of accounting and ten-key by touch

Verbal and written communication skills

Ability to work independently and collaboratively

Knowledge of medical terminology

Ability to operate basic office equipment

High attention to detail, strong organizational and multitasking abilities.

Schedule

Typically Monday – Friday day shift hours.

Education Requirements

High school diploma or equivalent education.

Experience

2-5 years of experience in medical billing, provider enrollment, or healthcare administration preferred.

CPCS(Certified Provider Credentialing Specialist) credentials preferred.

Benefits Package Available

Full-time benefits package includes medical, dental, vision, long-term disability (LTD), and life & accidental death and dismemberment (AD&D) insurance for you and your eligible family members, plus a 403(b) retirement plan with employer match.

Cabinet Peaks Medical Center is committed to providing a safe, efficient, and productive work environment for all employees. To help ensure a safe and healthful working environment, each applicant to whom an offer of employment has been made will be required as a condition of employment to undergo a substance test. Additional pre-employment items may be required. Please contact Human Resources for details.