Credentialing/Payor Enrollment Specialist- Cherry Hill NJ in Cherry Hill, New Jersey at Physician and Tactical Healthcare Services, LLC

Job
Title: Credentialing/Payor Enrollment Specialist

Department: Credentialing

Reports To: Manager of Credentialing

Work Schedule: Monday-Friday 8AM-4:30PM

Job Summary

The Credentialing/Payor Enrollment Specialist supports PATHS’ mission by assisting patients and families in securing appropriate health coverage, resolving billing issues, and advocating for financial resources. This role ensures accurate documentation, compliance with HIPAA and healthcare regulations, and contributes to timely revenue recovery for PATHS’ provider clients across multiple states.

Essential Duties & Responsibilities

· Submitting initial and re-credentialing payor enrollment application for Medicare and Medicaid enrollment.

· Submitting initial and re-credentialing payor enrollment applications for commercial enrollment.

· Follow up and check status of submitted applications with payors.

· Track and follow-up to obtain provider ID numbers and effective dates.

· Develop working knowledge of payors enrollment process for multiple states.

· Serve as a liaison between billing department and the payors on troubleshooting claims denials due to provider enrollment issues.

· Maintain matrix of all facility and provider expiring credentials needed for provider enrollment.

· Maintain high level of organization while being extremely focused on details.

· Performs other related duties as assigned. *

Supervisory Responsibilities

This position has no supervisory responsibilities.

Required Skills & Abilities

• Excellent verbal and written communication skills.

• Excellent interpersonal and customer service skills, including ability to interact with diverse patient populations and healthcare professionals.

• Ability to maintain confidentiality of protected health information (HIPAA compliance required).

• Strong organizational, analytical, and problem-solving skills.

• Ability to meet established productivity and accuracy standards.

• Proficient with Microsoft Office Suite (Outlook, Word, Excel); familiarity with EMR and payer portals preferred.

Education & Experience

High school diploma or GED required; post-secondary education preferred (role-specific). Minimum two years of payor enrollment experience required CAQH and payor portal experience recommended

Physical & Environmental Requirements

• Prolonged periods sitting at a desk and working on a computer.

• Frequent movement in hospital or office settings, including walking between patient rooms and departments.

• Occasional lifting of up to 15 pounds.

• Must have reliable transportation and valid driver’s license for travel to client sites as required.

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pre-Employment Requirements

Offers of employment are contingent upon successful completion of applicable screenings consistent with federal, state, and local laws.

Screenings may include: Background check, drug screen, physical exam, PPD screening, and verification of immunization records (role-specific). Employment eligibility will be verified through I-9/E-Verify. Because PATHS operates in the healthcare industry, certain screenings (e.g., OIG/GSA exclusion checks, state Medicaid exclusion lists) may be conducted on a recurring basis as required by federal and state law, client contracts, and hospital compliance programs.

Compensation & Benefits

Compensation: $20.00 – $24.00/hour (actual range provided in postings as required by applicable state pay transparency laws). Benefits include: Paid Time Off, Paid Holidays, Medical, Dental, Life Insurance, Short-Term Disability (STD), Long-Term Disability (LTD), and a 401(k) Plan with company match.

EEO & Compliance Statement

PATHS is an Equal Opportunity Employer and complies with all applicable federal, state, and local employment laws. We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, or any other status protected by applicable law. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions