Credentialing and Billing Operations Specialist

About Us

Red Cell Partners is an incubation firm building and investing in rapidly scalable technology-led companies that are bringing revolutionary advancements to market in three distinct practice areas: healthcare, cyber, and national security. United by a shared sense of duty and deep belief in the power of innovation, Red Cell is developing powerful tools and solutions to address our Nation’s most pressing problems. 

Location: Virtual

Reports to: VP Strategy & Operations

Work Schedule: Full-time

Company Overview:

Savoy Life is a healthcare startup focused on improving senior living. Savoy Life’s model of care aims to support senior living communities and help tie residents, their caregivers, and the providers within the community together. This is done by partnering with senior living communities to coordinate and manage clinical gaps for residents to improve these facilities’ core business drivers. We deploy our own team of​ clinical experts both in-person and virtually paired with technology to provide instant leverage and relief for the facilities’ staff and fill gaps in care not always met by existing providers in the community. We honor residents’ existing care team including primary care via wraparound services to​ give residents the high-quality care and support they deserve, on​ their terms.

Job Overview:

Savoy Life is seeking part-time Credentialing and Billing Specialist to support credentialing and revenue cycle management / billing. This is a fully virtual role that will largely work independently that will on own the end-to-end credentialing process through billing setup and the entirety of the revenue cycle. This starts with identifying health plans/IPAs to contact, reaching out to those companies, setting up Savoy’s entity plus providers, and monitoring. The second aspect of this role is ensuring that the credentialing setup translates into accurate and timely claim reimbursement by managing payer configurations (ERA, EDI, eligibility) in Savoy’s EHR. The third key aspect is coordinating with the RCM vendor to manage and resolve billing discrepancies.

Key Responsibilities:

Credentialing & Enrollment

• As Savoy enters new states, identify and prioritize health plans and IPA groups to reach out to as well as the processes to do so
• Manage and drive the initial credentialing and re-credentialing of healthcare providers with health plans and IPA groups (Medicare, Medicaid, Commercial plans, etc.) including identifying contacts to reach out to when barriers arise such as leveraging leadership’s LinkedIn contacts
• Prepare, review, and submit enrollment applications and supporting documentation to health plans and IPAs
• Track and follow up on application statuses to ensure timely approval
• Maintain and update provider credentialing files in accordance with regulations
• Communicate with insurance companies and the internal team to resolve credentialing and enrollment issues
• Collect, review, and validate credentials for our clinical team including licenses, certifications, and education
• Ensure compliance with federal, state, and payer-specific requirements
• Maintain a credentialing database ensuring all required documents are up to date and complete

RCM/Billing

• Setup and maintain Electronic Remittance Advice (ERA), Electronic Data Interchange (EDI), and eligibility verification connections within the EHR system
• Coordinate and continuously improve all revenue cycle processes and activities including billing, collections, payment posting, patient financial services, and all other RCM related items
• Monitor and fullly own the claims denials process by identifying root causes and implementing corrective actions while adhering to compliance requirements
• Verify that claims are paid in accordance with contracted rates and credentialing setup for each payer and provider
• Coordinate with the RCM vendor to resolve discrepancies between credentialed status and actual reimbursement received as well as troubleshoot issues related to claim denials, eligibility rejections, or enrollment lapses
• Maintain and monitor compliance with health plan contractual requirements and Savoy’s policies
• Submit appeals/claim corrections as needed within timely filing limits
• Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients
• Oversee and monitor the performance metrics of RCM overall including weekly, monthly, YTD tracking to share with leadership
• Validate provider IDs, NPI numbers, and taxonomies are correctly configured in billing and EHR platforms

Required Qualifications:

• Extensive experience in healthcare provider credentialing & enrollment
• Credentialing experience must extend beyond working at a health plan and must be comfortable starting the credentialing process from scratch
• Knowledge of payer enrollment processes, CAQH, NPPES, PECOS, and insurance verification
• Extensive experience in healthcare end to end revenue cycle management (EDIs/ERAs to charge posting to denial management etc.) and process improvement
• Proficiency in Microsoft Office (Excel, Word, Outlook) including Excel analytics, billing software, and credentialing software

What You Bring:

• Comfortable working with little to no structure and building structure from the ground up (this is a startup, and this is the only role to support credentialing & RCM today) paired with clear expectations of outputs
• Ability and desire to learn and grow with a belief in the growth mindset
• Strong attention to detail, organizational, and communication skills
• Strengths with working proactively and problem solving independently before escalating support
• Self-starter and ability to execute tasks and improvement initiatives without daily direction

Benefits: 

• 100% employer paid, comprehensive health care including medical, dental, and vision for you and your family
• Unlimited PTO, with management approval
• Paid maternity and paternity for 14 weeks at employees' normal pay
• Optional 401K, FSA, and equity incentives available

Join us in reimagining senior care delivery and empowering older adults to live healthier, more independent lives. If you are passionate about innovation, operational excellence, and improving the well-being of seniors, we want to hear from you!

Salary Range: $65,000-$75,000. This represents the typical salary range for this position based on experience, skills, and other factors.

We’re an Equal Opportunity Employer: You’ll receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, protected veteran status, or on the basis of disability.