The Payer Relations Specialist coordinates and performs all aspects of the provider credentialing and recredentialing process to ensure healthcare providers meet regulatory, accreditation, and payer participation requirements. Supports compliance with federal and state regulations, accreditation standards, and internal policies by verifying provider qualifications, maintaining accurate credentialing records, and ensuring timely submission and approval of credentialing applications. Collaborates closely with Medical Staff Services, Revenue Cycle, Compliance, and Payer Enrollment teams to ensure providers are credentialed and approved prior to rendering services and billing for services.
Work Experience:
Two years of experience as a physician credentialing within a hospital or healthcare system.
Education and Training:
High school diploma or equivalent required. Associate’s degree in Healthcare Administration, Business Administration, or related field preferred.
Skills:
- Understanding of provider credentialing and recredentialing standards, processes, and verification requirements
- Knowledge of federal, state, payer, and accreditation standards affecting provider credentialing
- Knowledge of primary source verification methods and documentation requirements
- Familiarity with credentialing software and provider databases, including CAQH, PECOS, TMHP, and NPPES
- Knowledge of provider licensure, certification, education, and professional history documentation
- Strong attention to detail and document management skills for audit-ready credentialing files
- Ability to manage multiple credentialing files and deadlines in a regulated healthcare environment
- Maintaining accurate, organized, compliant credentialing records using standardized checklists
- Identifying discrepancies and resolving credentialing issues
- Strong written and verbal communication skills to interact with providers, payers, and teams
- Explaining credentialing requirements, timelines, and processes clearly
- Collaborating cross-functionally with departments
- Proficiency with Microsoft Office (Word, Excel, Outlook) for tracking, reporting, documentation
- Adherence to confidentiality, HIPAA, and compliance standards
- Adapting to regulatory changes and applying updated credentialing requirements consistently
Location: University Medical Center of El Paso Schedule: Full Time, Days, 8:00 AM to 5:00 PM
- Minimum two years of experience in physician credentialing within hospital or healthcare system
- High school diploma or equivalent required; Associate’s degree preferred
- Knowledge of credentialing standards, processes, software, and databases
- Strong organizational and communication skills
- Ability to adhere to HIPAA and confidentiality standards
Location
El Paso, Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago