Credentialing Specialist Jobs

Variantyx is a technology-driven precision medicine company providing state-of-the-art diagnostic

solutions for the rare genetic disorders and reproductive genetics markets, and treatment optimization in

oncology. We are transforming precision medicine.

Our proprietary whole genome analysis platform allows us to better understand a person’s genetic

makeup, leading to unmatched diagnostic capabilities and improved personalized treatment

recommendations.

About the position:

The Credentialing Specialist will conduct all aspects of third- party credentialing for our organization

internally and externally.

Duties & Responsibilities:

• File provider practice change notifications and perform follow up duties till confirmed complete by payors.
• Manage and/or facilitate internal and external credentialing projects as necessary.
• Address enrollment disconnects.
• Negotiate and update payer fee schedules as allowed per contract.
• Track provider licensure and Board expirations and ensures timely processing and payor updates.
• Completes Enrollments for all payer electronics transactions (i.e., 835, 837, payer portal logins, etc.)
• Maintains Payer Records in all systems (Salesforce, Imspro, XiFin, etc)
• Complete requests for re-credentialing
• Accept and process all requests from payers for credentialing information/updates/new contracts and products.
• Update NPI records according to provider specifications.
• Answer questions, process requests from staff/providers related to credentialing information.
• Process and file applications with third party payors according to each payor’s individual requirements and addresses/corrects discrepancies as requested by payors.
• Enrolls Laboratory in Medicare/Medicaid programs.
• Updates Internal staff of payer policies as it pertains to our testing.
• Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing software,
• Enroll provider in Medicare/Medicaid as prescribed by each program requirements.
• Conduct all follow up steps till payor approval/completion is obtained.
• Prepare and maintain credentialing files and reports including maintenance of credentialing software,
• Serves as liaison between Variantyx and outside organizations and external customers.
• Identifies and resolves claim denials that occur due to lack of participation.

Education, Experience & Skills:

• Detailed knowledge of the various state Medicaid agency requirements with respect to changes (e.g. name change, indirect ownership changes, address changes, officer changes.)
• Six (6) years of regulatory filing preferred.
• Strong verbal and written communication skills. Openness to share and receive information and ideas from all levels of the organization.
• Ability to maintain a high level of attention to detail and follow up skills.
• Certified Provider Credentialing Specialist (CPCS) desired or 6 or more years of on the job Provider Enrollment experience.
• College degree preferred.
• Proficient in Microsoft Office Suite and general working knowledge of Internet for business use.
• Team player. Willing to work with the team to achieve team and organizational goals.