Healthcare Customer Service Advocate | Provider Credentialing
Position Summary:
The Healthcare Customer Service Advocate – Provider Credentialing manages the end-to-end credentialing process for healthcare providers and practices. This includes preparing, submitting, and tracking applications, maintaining accurate documentation, and coordinating with providers and payers to ensure all requirements are completed. The role is responsible for monitoring accounts and ensuring timely and compliant credentialing from start to finish.
Duties and Responsibilities:
- Monitor all documents and data exchanged within the Credentialing database in order to ensure quality of services, and accurate completion of Credentialing forms and processes. Coordinate with Providers to insure that proper enrollment ensues based on individual Payer requirements.
- Organize, label and file Credentialing forms, applications and documents.
- Document all Credentialing packages prior to transmitting them to Payer. Coordinate with the Payer to ensure that all Credentialing requirements are met.
- Train clients (Providers/Office Staff) how to use all features of the Credentialing application services
- Submit Credentialing forms and applications to Payers as needed.
- Complies with all Federal, State, accreditation and institutional policies and procedures.
- Consistently meets company and department policies and expectations including those surrounding attendance
- Exhibits exceptional internal and external customer service with all persons with whom you work
- Maintains confidentiality at all times.
- Observe security responsibilities including, but not limited to:
- Utilize appropriate communication channels for the movement of data. If using email, use the secure email option. If in FTP, utilize SFTP or encryption of the data before sending. Send messaging via application to utilized TLS protocols.
- Use minimum data necessary to identify transactions. Claim ID, Claim File Upload ID, ERA Trace Number/Check ID. Only when those identities are not enough for the recipient to find the transaction, then use the minimum PHI needed to identify the transaction.
- Security is everyone’s job. Look out for, and report, anything that is suspicious or just doesn’t seem correct
Key Success Factors:
- Technically competent, organized, intuitive and personable.
- Will be able to develop new skill and learn quickly.
- Show desire to be innovative and self-reliant.
- Coordinate and monitor management of Credentialing data and documents. Communicate with other departments (Sales/Support) when a Provider is approved.
- Able to communicate successfully with clients with consistently positive feedback
- Regularly meets the productivity and accuracy requirements established
Required Qualifications (Non-Negotiable):
- Associate degree or equivalent experience preferred
- Must have call center/BPO experience with at least 2 years in healthcare, specifically in Provider Credentialing
- With basic credentialing knowledge and familiarity with industry standards
- Strong understanding of healthcare concepts, including terminologies, eligibility and benefits, medical/dental claims, and policy process flow
- Proficient in Adobe PDF, MS Office applications, and internet tools
- Excellent analytical, organizational, and time management skills with strong attention to detail
- Effective communication and interpersonal skills, with the ability to coordinate with internal and external stakeholders
- Highly adaptable, detail-oriented, and capable of multi-tasking and prioritizing in a fast-paced environment
- Demonstrates professionalism, discretion, patience, and flexibility when handling tasks and interactions
**Work Arrangement: This position is currently offered on a REMOTE work basis. However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.
***WORK FROM HOME REQUIREMENTS***
- Requires a stable primary internet connection of at least 50Mbps,
- Reliable backup connection to ensure continuity of remote work.
- Speed test required during interview.
- Ability to directly hardwire to your modem
- Quiet, dedicated work area.
Why You’ll Love Working with Us:
- Work Remotely
- Competitive Pay + 13th Month Salary
- Comprehensive HMO Coverage (Medical & Dental)
- Equipment Provided – Everything you need to succeed
- Career Growth – Be part of a dynamic and supportive team that values your expertise
- ⚡ Immediate Hiring – Start ASAP and make an impact from day one
COMPANY OVERVIEW:
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.