Payor Relations Specialist

2 weeks ago

India Zealie Full time ₹ 6,00,000 - ₹ 12,00,000 per year

**This is a Remote position**

About Zealie:

Zealie is a fast-growing Medical Billing company specializing in the Behavioral Healthcare industry. Our clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis. Our state of the art proprietary technology provides data analytics and revenue prediction tools to our clients to help them make strategic business decisions to grow their business. We are committed to delivering exceptional products and services to our clients and believe that our Payor Relations team plays a crucial role in achieving this mission. We are seeking motivated individuals with a desire to be a part of a winning team.

Job Summary:

Under the supervision of the Payor Relations Team Lead, the Payor Relations Specialist is responsible for enrolling Zealie's clientele with the insurance companies in an effort to streamline claim processing and payment. This position entails additional responsibilities such as locating supporting documentation by utilizing Google spreadsheets, drives, folders and documents; and, communicating with internal and external personnel.

Responsibilities and Duties:
  • Submit required documentation to insurance companies to update the client's demographic information (business name, mailing address, physical address, etc)
  • Submit updated information to insurance companies upon request (licensure, accreditation, W9, professional liability insurance, etc)
  • Update the provider profile on file with insurance as needed
  • Contact insurance companies to link the client's NPI and Tax ID
  • Enroll the client in Electronic Remittance Advice ("ERA")
  • Enroll the client with insurance companies for Electronic Funds Transfer ("EFT")
  • Create online insurance portal access for Zealie employees to utilize
  • Submit application or documents for Credentialing Re-credentialing request.
  • Keep CAQH updated for our clients.
  • Utilize internal Google spreadsheets, drives, folders and documents to locate additional information required to complete each project
  • Proactively follow up with insurance companies within the standard turnaround time
  • Work closely with the Collections Manager and/or Team Lead (s) on project deadlines

  • Report directly to the Payor Relations Manager and/or Payor Relations Team Lead (s) to routinely communicate the work progression and the completion of the project(s)

  • Document appropriate follow up notes on accounts and keep meticulous notes and spreadsheets as required

  • Maintains confidentiality of all pertinent patient care information to assure patient rights are protected
  • Perform additional duties as requested by Management team
Qualifications and Skills:
  • Minimum of 2-3 years experience in the Credentialing process
  • Minimum 6 months experience in Behavioral or Mental Health Credentialing
  • Extensive knowledge of In-network Contract request submission online and offline
  • Excellent organizational skills
  • Effective communication skills, both verbal and written via phone and email
  • Proficiency in Google Products including Google Workspace, Google Drive, Google Sheets, Google Docs
  • Ability to navigate various technology and software tools
  • Multi-task using all available resources
Education and Experience:

  • Bachelor's degree or higher degree in any stream

  • 3+ years of experience in Credentialing

  • Minimum 6 months experience in Behavioral or Mental Health Credentialing
(Preferred):
  • Extensive knowledge of Behavioral and Mental Health Credentialing and Contracting
  • 3+ years work experience on paper in Credentialing process
  • Having good experience of CA, AZ, TX, FL, NJ, CO & HI state credentialing guidelines
  • Experience handling 50+ credentialing requests per week.

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