Remote | Full-Time | Long-Term Contract

We are a growing U.S. healthcare Revenue Cycle Management (RCM) company looking for an experienced Provider Credentialing & RCM Denials Specialist who is comfortable wearing two hats.

This is a remote position combining provider credentialing and payer contracting with denial management and A/R follow-up. We are specifically looking for someone who has hands-on experience in both areas, not someone whose experience is limited to credentialing or only to A/R calling.

The primary responsibility will be credentialing and contracting. During periods when credentialing volume is lighter, you will support our RCM team with denial resolution and insurance A/R follow-up.

This is a fully remote, long-term contract position for someone looking to grow with our team.

Key Responsibilities: Provider Credentialing & Contracting

- Handle end-to-end credentialing and recredentialing for individual providers and medical/behavioral health practices.
- Strong hands-on experience with New Jersey and Current York provider credentialing is highly preferred.
- Complete new provider enrollments, group enrollments, reassignment/linking, demographic updates, and revalidations.
- Manage CAQH profiles, including attestations and maintaining accurate provider information.
- Work with PECOS, Medicare, Medicaid, and commercial payer portals.
- Handle payer contracting and network participation requests.
- Follow up directly with insurance companies regarding application and contracting status.
- Track applications, reference numbers, effective dates, missing documentation, follow-up dates, and deadlines.
- Maintain organized credentialing trackers and supporting documentation.




- Identify enrollment issues and proactively work with payers to resolve them.
- Communicate credentialing status and potential delays clearly to management and clients.

Experience working with major NJ/NY payers such as Horizon BCBSNJ, Aetna, Cigna, UnitedHealthcare/Oxford, Medicare, NJ FamilyCare/Medicaid, NY Medicaid, Healthfirst, EmblemHealth, Fidelis/Centene, and similar regional plans is a strong advantage.

Denials & Accounts Receivable

When credentialing workload permits, you will support our RCM operations by:

- Reviewing and resolving denied and rejected claims.
- Investigating the actual root cause of denials rather than simply resubmitting claims.
- Working denials related to eligibility, authorization, credentialing, coding/modifiers, timely filing, medical necessity, COB, provider enrollment, and payer processing issues.
- Reviewing EOBs/ERAs and payer correspondence.
- Correcting and resubmitting claims when appropriate.
- Preparing and submitting reconsiderations and appeals.
- Performing insurance A/R follow-up on unpaid or underpaid claims.
- Calling insurance companies and using payer portals to obtain claim status.
- Documenting every follow-up clearly in the billing system.
- Identifying recurring denial trends and escalating systemic issues.
- Following claims through to final resolution rather than simply documenting status.

Required Experience





We are specifically looking for candidates who meet both sides of this position:

- 3 years of U.S. healthcare RCM experience preferred.
- Strong written and spoken English.
- Excellent documentation and follow-up skills.
- Comfortable working independently in a remote environment.

Position Details

Job Type: Full-Time, Long-Term Contract

Work Location: Fully Remote

Industry: U.S. Healthcare / Revenue Cycle Management

Primary Function: Provider Credentialing & Contracting

Secondary Function: Denial Management & Insurance A/R Follow-Up

Pay: ₹30,000.00 - ₹45,000.00 per month

Benefits

- Work from home

Application Question(s):
- How many years of hands-on U.S. provider credentialing experience do you have?
- Have you personally worked with CAQH, PECOS, Medicare, Medicaid, and commercial payer enrollment portals? Please briefly explain.
- Which New Jersey and New York payers have you personally completed credentialing or contracting applications with?
- Who is the MAC for NJ and for NY state?
- How many years of experience do you have working insurance denials and A/R?
- What types of denials have you personally investigated and resolved?
- What is CO 29? Can you please explain the denial and briefly outline the steps to address it?
- Are you comfortable working in a role where your responsibilities may shift between credentialing and denial/A/R work depending on workload?
- Are you comfortable calling U.S. insurance companies for both credentialing follow-up and claim follow-up?
- What is your expected compensation?
- If selected, how soon can you join this new role with our organization?

Work Location: Remote

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