Payor Credentialing Specialist

GeneDx•Gaithersburg, MD

12h•$30 - $38•Remote

About The Position

The Payer Credentialing Specialist at GeneDx plays a pivotal role in ensuring the company receives appropriate reimbursement for services by managing timely and precise payer enrollment, reenrollment, and credentialing processes. This position is vital for maintaining compliance with regulatory standards and establishing relationships with commercial and government payers.

Requirements

A college or university degree is preferred. However, relevant experience can be accepted instead of a degree.
2-3 years’ experience in healthcare roles with emphasis in credentialing and enrollments, payer policy, or contracting with payer organizations.
Able to handle multiple priorities and consistently meet deadlines.
Ability to identify issues or gaps in processes, problem-solve, gather feedback and implement solutions.
Strong technical skills – Microsoft Excel, Word, etc.
Ability to handle sensitive and confidential information appropriately.

Responsibilities

Execute the credentialing of in-network and out-of-network commercial and government payers
Achieve and maintain PECOS certification
Handle enrollment processes in line with state and federal regulations
Proactively address and resolve issues, proposing actionable solutions
Conduct follow-up with regulatory agencies and payers as necessary
Handle requests for payer roster assessments, ensuring accurate and up-to-date listings within payer networks
Collaborate with the Finance Department to establish single case agreements
Manage the setup and maintenance of EDI/EFT accounts to ensure payment accuracy
Oversee payer portal updates and access for both internal and external stakeholders
Oversee all aspects of payer communication, updates, and management, excluding contract negotiations. This includes maintaining relationships with various payers, staying updated on payer requirements, and ensuring regulatory compliance, all on an ongoing and ad hoc basis.
Maintain all necessary documentation for credentialing and enrollment processes and procedures
Build a collaborative relationship with internal/external staff
Assume additional responsibilities as needed within the department beyond the primary duties listed