Insurance Credentialing Representative

Job Description

This is a remote position.

Job Highlights:

• Contract type: Independent Contractor
• Night Shift Schedule: Monday to Thursday - 8:45am to 5pm New York Time (8:45pm - 5am Manila Time)
• Friday - 8:45am to 3:45pm New York Time (8:45pm - 3:45am Manila Time)

The desired result of the State Payor Credentialing Representative role is confident, end-to-end ownership of provider enrollment for assigned high complexity states. This role consistently ensures that provider enrollment applications for both commercial and government payors are submitted accurately, compliantly, and within expected turnaround times. As the subject matter expert for assigned state(s), the Credentialing Representative demonstrates deep understanding of state specific credentialing requirements and applies that expertise to guide submissions, resolve issues, and navigate complex regulatory environments. Enrollment activity is well managed from initial application through final approval, with clear accountability and minimal need for escalation. Clients, Account Teams, and internal leadership experience credentialing as reliable, organized, and proactive. Re-credentialing timelines are anticipated, documentation gaps are identified early, and payor requirements are consistently met.

Measures of Success:

• 100% verification of required data: All client required information is confirmed prior to initiating enrollment applications.
• Submission timeliness: New provider applications are submitted within 8 working hours of receiving complete information.
• Applications for new payor contracts are submitted within 3–5 business days of receiving complete information.
• Proactive communication: Daily activity and follow up reports are consistently sent to the Credentialing Representative II or State Payor Credentialing Coordinator.
• Application accuracy: Application denial rate remains below 1% across all submissions.

Responsibilities:

• Lead the submission of provider enrollment applications for assigned states with complex regulations or high provider volume.
• Serve as the primary subject matter expert for credentialing and enrollment requirements in assigned state(s).
• Maintain current knowledge of both In-network and out-of-network enrollment processes.
• Partner with Account Coordinators to validate provider data and documentation prior to initiating enrollment applications.
• Establish and maintain productive working relationships with payor representatives in assigned states to support clear communication and timely issue resolution.
• Prepare and submit provider enrollment documentation through appropriate channels, including payor portals and mailed submissions.
• Track application status and perform proactive follow ups to drive timely approvals.
• Manage re-credentialing submissions and communicate upcoming client requirements to Account Management.
• Complete quarterly and other required payor attestations to ensure ongoing compliance.
• Provide daily status reports to Credentialing Coordinator, including updates for personal workload and any Credentialing Representative I staff supporting assigned states.
• Maintain thorough documentation of all submissions, follow ups, and payor correspondence within internal tracking systems.

Knowledge/skills/abilities:

• Exceptional attention to detail and strong organizational skills.
• Critical thinking and problem-solving abilities in complex or ambiguous situations.
• Ability to work effectively in a fast-paced, deadline-driven environment.
• Clear and professional verbal and written communication skills.
• Strong reading comprehension and ability to interpret regulatory and procedural guidance.
• Professional yet assertive communication style when working with payors to drive timely outcomes.

Education/experience required:

• At least 2 years in college
• Two years experience in US-based medical billing practice or
• Two years experience in a medical practice dealing with billing including but not limited to, provider credentialing, authorizations, reimbursement, etc. preferably in Behavioral Health to some degree

MBH Core Values: We hire/fire/promote based on these core values + job-specific performance:

1. Respectful of our unique cultural environment
2. Absolute Confidentiality
3. Embracing Teamwork
4. Loyal Behavior & Positive Attitude
5. Accountability
6. Proactiveness
7. Thoroughness
8. Focused on results
9. Inspired to learn & grow constantly
10. Devoted to providing top-tier services to our clients through the "Unique Service Oriented Philosophies"

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Steady freelance job
• Profit sharing incentive
• Paid time off
• Holiday pay
• Annual Performance and Raise Evaluation
• Quarterly Perfect Attendance Incentive
• HMO
• BruntWork Loan Assistance

Please note that since this is a permanent work-from-home position and an “Independent Contractor” arrangement, the candidates must have their own computer and internet connection. They will handle their own benefits and taxes. The professional fees are on hourly rates and the rate depends on your performance in the application process.

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