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Credentialing and Insurance Specialist

AllerVie Health

Frisco, TX, US
  • Job Type: Full-Time
  • Function: Accounting/Finance
  • Industry: Healthcare
  • Post Date: 07/04/2024
  • Website:
  • Company Address: 5830 Granite Pkwy #100-243, Plano, TX 75024

About AllerVie Health

Bringing relief and renewed vitality to those affected with allergies, asthma, and other immunological disorders.

Job Description

 At AllerVie Health, our team members are unified around our mission to help patients achieve and maintain optimal health and quality of life -- free from the symptoms and suffering of allergies, asthma, and related immunological conditions. From our physician and clinical roles to our administrative and operational support roles and everything in between — we change lives for the better — giving people their lives, health, and vitality back in real, tangible ways. We live every day on mission and wake up excited to tackle new challenges and provide people with health solutions.
When you join AllerVie, you join a crucial workforce that provides meaningful care and service to our allergy patients.  We value the knowledge and experience you bring to AllerVie and we reward your efforts and dedication with a competitive compensation and benefits offering that allow you to offer your best to our patients.  These benefits include the following for full-time employees (scheduled 30+ hours weekly):
  • Eligible for benefits the first of the following month after date of hire
  • (3) major medical plan offerings
  • Dental and vision plan offerings
  • Supplemental benefit offerings:  accident, critical illness, hospital indemnity, short-term and long-term disability, supplemental life insurance, flexible spending and dependent care spending plans
  • Company paid benefits:  $50K basic life and AD&D insurance, Teladoc plan for employee and dependents at no cost, Employee Assistance Program to include work/life balance resources and counseling
  • 401k Plan with VOYA after 6 months of AllerVie employment.  Company match of 100% of the first 3% of employee contributions.  50% for the next 2% of employee contributions. 
  • Generous paid time off that increases with years of service
  • Paid holidays
Job Summary:
The Credentialing and Insurance Specialist will be responsible for administrative billing support including the following:
  • Enroll and credential providers (e.g. physicians, facilities, physician assistants, nurse practitioners, etc.) with insurance companies
  • Clearly and effectively communicate with providers, practices and insurance companies with the day-to-day operation of credentialing and enrollments
  • Support provider medical licensing requests
  • Document credentialing and network status and communicate with practices to ensure patients are seen by credentialed and in network providers
  • Follow up with clients and insurances for timely credentialing process(es)
  • Review, and update, health plan directories, agencies, and other appropriate entities for current and accurate provider information
  • Maintain access to insurance and government payer portals and share with business contacts as needed
  • Knowledge of provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards
  • Work with RCM team to determine the root cause for credentialing and payer network related denials from insurance carriers and develop solutions to resolve
  • Support payer contracting, escalations, and contract negotiation strategy as needed
  • Support payer setup in our EMR system and clearinghouse for billing
  • Perform other duties as assigned
  • High school degree or equivalent required. Bachelor’s degree in business, healthcare related field preferred or equivalent experience
  • Experience in credentialing or other medical experience relevant to insurance carrier credentialing
  • Excellent organizational skills
  • Strong analytic and problem-solving abilities
  • Excellent verbal and written communication skills
  • Able to maintain confidentiality.
  • Experience with Microsoft Office-Excel, Word, PowerPoint and the ability to master programs needed for position
  • Must be able to work independently
AllerVie Health is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law. 

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