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Credentialing Specialist - Market Access
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Job Description
- Req#: CREDE002206
Job Summary: Baylor Genetics (BG) is expanding its market access capabilities. BG has extensive experience in the hospital setting and is expanding its business to the outpatient setting. BG seeks coverage and reimbursement for genetic testing with commercial health plans to serve patients with answers that matter. To that end, we are hiring a Credentialing Specialist to facilitate the end-to-end process of provider enrollment submissions to Medicare, Medicaid, Tricare, as well as Commercial credentialing to ensure effective contracting and billing operations.
Key Responsibilities:
• Complete Initial Credentialing & Re-Credentialing applications to gain in-network status with commercial payors & Managed Medicaid payors
• Manage and track application submissions via Salesforce
• Perform timely follow-ups with payers
• Collaborate closely with Market Access Team to gather necessary information and documents for network expansion initiatives
• Serve as point person for assigned payers to resolve application and enrollment issues
• Monitor expiration dates for assigned payers and enrollments to ensure timely renewal and prevent lapses in participation
• Ensure compliance with payer specific requirements and state/federal regulations
Skills and Competencies:
o Strong Data Entry, Document Management, and Record-keeping skills
o Strong Research skills to verify information
o Intermediate to Advanced Proficiency in programs like Word & Excel
o Effective written/oral communication skills to interact with providers, insurance companies, and other stakeholders
o Intermediate knowledge of healthcare laws and compliance standards
o Strong ability to efficiently manage time & meet deadlines
o Strong knowledge of applicable software programs; Salesforce is a plus
o Ability to work independently as well as collaborate with a team
Education and Experience:
o Preferred bachelor's degree with experience of 3 years in Credentialing Services
o Certified Provider Credentialing Specialist (CPCS) preferred
o In lieu of degree, 5 year's minimum experience in Credentialing Services
o Diagnostic Laboratory experience preferred
o State Medicaid Provider enrollment experience preferred
Physical Demands and Work Environment:
• Frequently required to sit, talk, and hear.
• Regular use of computer, keyboard, and standard office equipment.
• May be required to manage priorities in a fast-paced, deadline-driven environment.
Equal Opportunity Employer
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