Job Description

Provider Credentialing & Accounts Receivable Specialist

???? Now Hiring: Provider Credentialing & Accounts Receivable Specialist

Location

Linthicum, MD

Reports To

Vice President, RCM Operations

Employment Type

Full-Time

Role Overview

CoreLife is seeking a detail-oriented and highly motivated Provider Credentialing & Accounts Receivable Specialist to join our team. This dual-function role is critical in ensuring accurate provider enrollment, maintaining credentialing compliance, and supporting revenue cycle operations. If you have a strong background in medical credentialing, payer enrollment, and A/R managementand enjoy working in a fast-paced, mission-driven environment wed love to hear from you!

Key Responsibilities

• Prepare and submit provider enrollment applications and supporting documentation across multiple payers.
• Maintain accurate and compliant records for licenses, certifications, and insurance contracts.
• Track and process new enrollments, revalidations, ERN/ERA submissions, and roster updates.
• Coordinate with HR, providers, and billing teams to streamline onboarding and credentialing processes.
• Manage CAQH profiles and update PECOS and NPPES as needed.
• Maintain HIPAA-compliant credentialing files and communication with payer credentialing teams.
• Review and manage aging A/R >30 days, ensuring timely follow-up and maximum reimbursement.
• Address denied claims, rework errors, file appeals, and communicate with payers as needed.
• Monitor payer reimbursements against contracted rates.
• Provide coverage and support across the team during absences or high-volume periods.
• Work within EPIC and NextGen systems, and utilize EMR tools for charge entry and collections tracking.

Required Qualifications

• High school diploma or equivalent.
• Minimum 3 years of experience in provider credentialing and/or medical billing.
• Experience with PECOS and ePREP.
• Knowledge of payer requirements and CPT/ICD-10 coding.

Preferred Qualifications

• Associate or Bachelors degree in healthcare, business, or related field.
• 5+ years of experience in credentialing and A/R management.
• Experience with EPIC and NextGen.
  
• Familiarity with NCQA standards and processes.
• Exceptional attention to detail and organizational skills.
• Ability to multitask, prioritize, and work independently.
• Strong problem-solving and critical thinking capabilities.
• Excellent communication and interpersonal skills.
• Proficiency with Microsoft Excel and payer web portals.
• Commitment to confidentiality and HIPAA compliance.

About CoreLife

At CoreLife, we are committed to delivering exceptional patient outcomes and creating a supportive, respectful environment for our team. Youll be part of an innovative, growing company dedicated to transforming healthcare through integrated, whole-person care.

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