The Senior Client Service Executive will oversee and manage the entire provider credentialing and re-credentialing process with insurance companies. This involves maintaining and updating provider data, verifying critical information, and tracking applications for approval. The role requires close collaboration with various teams and stakeholders to ensure compliance and resolve any payment or denial issues. The executive will also support the revenue cycle by keeping providers active and eligible for billing.
Responsibilities
- Manage and lead a team of credentialing specialists, providing guidance and support.
- Handle end-to-end provider credentialing and re-credentialing, ensuring timely and accurate submissions.
- Maintain and update provider data in internal systems and payer portals, keeping records up-to-date.
- Verify provider information, including NPI, CAQH, state license, DEA, and malpractice insurance, for accuracy.
- Track credentialing applications and follow up with payers to obtain approval status promptly.
- Collaborate with the AR team to address denials or payment delays due to credentialing issues, ensuring smooth revenue flow.
- Maintain comprehensive documentation of all credentialing activities, ensuring compliance with payer requirements.
- Communicate regularly with providers and internal teams, providing status updates and requesting missing documentation.
- Support the revenue cycle by keeping providers active and eligible with payers, minimizing billing disruptions.
Qualifications
- Bachelor's degree in healthcare administration or a related field is preferred.
- Minimum of 1 to 4 years of experience in AR, credentialing, and enrollment within the US healthcare industry.
- Strong leadership and management skills, with the ability to guide and motivate a team.
- Excellent organizational and time management skills, with an eye for detail.
- Proficiency in using credentialing software and systems, with the ability to learn new tools quickly.
- Strong communication and interpersonal skills, with the ability to build relationships with providers and internal teams.
- Knowledge of healthcare regulations and compliance standards, especially related to credentialing.
- Ability to work independently and manage multiple tasks and priorities effectively.
- Analytical skills to identify and resolve credentialing issues and improve processes.
- A proactive and solution-oriented approach to problem-solving.
