Sr. Credentialing & Revenue Cycle Specialist
About Cayaba Care
Our mission is to improve outcomes in underserved communities by reimagining how maternity care is delivered. Our team is focused on building technology-enabled solutions to deliver holistic, home-based clinical and non-clinical maternity services.
To learn more about Cayaba Care, please visit www.cayabacare.com.
About the Job
We are seeking a Revenue Cycle Specialist to join the Market Operations Team in Philadelphia, reporting to the Market Operations Director. This role is based onsite in our Philadelphia office.
The Senior Revenue Cycle Specialist will handle all facets of the Revenue Cycle including provider credentialing, front/back-end billing tasks and collections for our clinic, telehealth, and home-based provider practices. In this position, you will accept payments from insurance companies, handle denials and appeals, and send bills to patients.
Our ideal applicant has experience in provider credentialing and accounts receivable, preferably in healthcare. Insurance industry expertise, especially regarding Medicaid and CPT medical codes, is required.
You will be a good fit for Cayaba Care if you:
- Have a passion for doing impactful work and improving maternal and newborn outcomes
- Ready to roll up your sleeves and build in fast-paced startup environments
- Have a deep commitment to diversity and inclusion
- Are a strong communicator
- Ability to work cross-functionally with diverse team with different skill sets
What You’ll Do
- Patient lifecycle support including but not limited to patient appointment tracking, demographic and insurance information collection, billing and financial counseling, and patient registration (as needed).
- Collect and post patient payments via inbound calls.
- Manage insurance verification, claims and denials submission and the appeals process.
- Create and follow up on required insurance preauthorizations and/or referrals.
- Run and analyze reports to track charges and accounts receivables on a monthly and ad hoc basis.
- Maintain Charge Master/Fee Schedule.
- Compile and maintain current and accurate records for all providers in our Credentialing database including up-to-date State Licenses, DEA certificates, Board Certifications etc.
- Complete credentialing and re-credentialing applications in a timely manner.
- Monitor applications and follow-up with payors accordingly.
- Maintain current CAQH database files for every provider per CMS guidelines every 120 days.
- Maintain current NPPES database files.
- Compile and submit or review, import, and return payor rosters in a timely manner.
- Complete online data verification/attestation through payor sites such as Availity or Lexis Nexus.
- Monitor general credentialing mailbox.
Who You Are
- An experienced credentialing and or payor enrollment professional (NJ or PA credentialing, OBGYN specialty preferred).
- Expert knowledge of professional fee billing, coding/billing, and medical terminology.
- Have excellent listening, written and verbal communication skills.
- An organizational wizard with a high attention to detail.
- Ability to multitask and be flexible regarding priorities and deadlines.
- Ability to maintain confidential information and work with executive leadership.
- Comfortable working both independently and on a team.
- Bachelor’s degree
- Experience with Athena
- Certifications such as CPC (Certified Professional Coder) and CCS (Certified Coding Specialist) preferred
- 7+ years of Healthcare Operations experience
- 7+ years of medical credentialing experience (OB/GYN preferred, not required)
- Advanced Google Workplace user
- Bachelor's Degree
- Intermediate computer and database management skills
What You’ll Get
- Hours: Full-Time/
- Location: Philadelphia, PA
- Type: In Office
- Salary: Competitive with market and level of experience
- Benefits: Health, Dental, Life insurance, 401K
Healthcare is Human: We partner with the communities we serve to address the unique needs of our patients and support whole person care.
Pursue Excellence: We earn & build trust with our patients, partners, & each other by striving for excellence without compromising our standards.
Uplift: We elevate and center underrepresented voices.
Embrace Innovation: We are creative & resourceful in getting things done.
Together, not alone: Moving maternal healthcare forward is a shared responsibility that we all care deeply about.