Credentialing /Payor Specialist (49144)

Capitol Imaging Services•Metairie, LA

1d•Remote

About The Position

Capitol 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.

Requirements

Expertise in healthcare credentialing/reimbursement, preferably radiology or diagnostics
5+ year of experience in provider credentialing payor enrollment and denial management
Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes
Proven success reducing denials and write-offs.
Ability to manage multiple providers and deadlines independently in a remote setting
Excellent written and verbal communication skills
Highly detail-oriented and deadline-driven
Comfortable with frequent follow-ups and documentation tracking, particularly in AR
Proficient with Microsoft Office and web-based systems
Self-motivated and able to work independently in a remote environment
Always maintains confidentiality and professionalism

Responsibilities

Reimbursement Strategy and Denial Prevention Take charge of the overall strategy to cut down on insurance denials and write-offs from payers
Identify, analyze, and prioritize root causes of denials and non-payment across modalities, payers, and sites
Design and implement systematic solutions to prevent recurrence
Identify denial trends and turn them into actionable operational SOP’s
Conduct follow up with payers and insurance companies to resolve claim denials and payment discrepancies
Investigate and resolve issues causing delays in payment or reimbursement, ensuring accurate claims processing
Assist i the identification of recurring denial patterns and recommend process improvement to reduce AR delays
Monitor and track outstanding accounts receivable (AR)
Credentialing/Payer Enrollment Collect, verify, and maintain facility/provider credentials
Prepare and submit initial and re-credentialing applications in accordance with organizational, payor, and regulatory requirements
Maintain accurate and complete electronic credentialing files
Track credential expiration dates and proactively manage renewals to prevent lapses
Complete and submit provider enrollment applications for Medicare, Medicaid, and commercial payors
Manage enrollments using CAQH, PECOS, NPPES, and payor-specific portals
Conduct regular follow-ups with payors to resolve delays, missing documentation, or application deficiencies
Confirm provider participation status and effective dates with each payor
Maintain up to date fee schedules
Maintenance & Compliance Update payors with changes to provider demographics, locations, group affiliations, and tax information
Ensure ongoing compliance with federal, state, and payor requirements
Maintain documentation for audits and internal reviews
Partner with billing, revenue cycle, and leadership teams to resolve credentialing- or enrollment-related claim issues
Remote Work Expectations Maintain reliable internet access and a secure, HIPAA-compliant remote work environment
Communicate effectively with internal teams via email, phone, and virtual meetings
Manage workload independently while meeting deadlines and productivity expectations