Medical Policy Specialist jobs in Portsmouth, NH

Credentialing Specialist

PMC Medical Group is a privately owned, multi-specialty medical group with locations throughout New Hampshire, providing care and compassion to patients for over 30 years, in the areas of pain management, family medicine and management of substance use disorders.

Job description:

The Credentialing Specialist will manage and monitor provider and facility credentials and maintain accurate data with insurance carriers to ensure a regulatory compliance and accurate payment from payers. The credentialing specialist will work closely with lead team members in Operations, HR and Accounting to ensure staff qualifications remain up to date and payer contracts remain competitive. Credentialing specialist will also work closely with the billing department to resolve any discrepancies with carrier payments.

The Ideal Candidate will have:

• Experience with insurance payor contracts,
• Knowledge of provider and facility licensing requirements for NH
• Knowledge and experience with Revenue Cycle Management
• Strong understanding of medical terminology and health insurance practices
• strong computer skills and experience working in electronic health record systems
• Minimum of HS Diploma, A.S. or B.S. preferred.

Salary dependent upon education and past experience.

As a team member at PMC Medical Group, you’ll enjoy:

• 9 Paid Holidays per year
• Accrued PTO
• Medical Benefits via an Individual Coverage Health Reimbursement Account (ICHRA)
• Dental
• Life Insurance & Disability
• 401k