Credentialing and Billing Operations Specialist – Part-Time

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: Part-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 Operations Specialist to support credentialing, billing as it relates to health plan setup and monitoring, and ad hoc operational needs. This is a fully virtual role that will largely work independently with the critical focus on owning the end-to-end credentialing and enrollment process. 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 critical aspect of this role is insuring that the credentialing setup translates into accurate and timely claim reimbursement by managing payer configurations (ERA, EDI, eligibility) in Savoy’s EHR and coordinating with the RCM vendor to resolve billing discrepancies.

This part-time role will start out focused only on credentialing for max 15 hours a week. If successful, this role can rapidly ramp up and add more responsibilities and therefore more hours. This is a 1099 position with the goal of converting to a W2.

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

Billing

• Setup and maintain Electronic Remittance Advice (ERA), Electronic Data Interchange (EDI), and eligibility verification connections within the EHR system.
• Monitor and 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
• Validate provider IDs, NPI numbers, and taxonomies are correctly configured in billing and EHR platforms

Operations

• Provide additional pockets of support such as managing Savoy’s accounts payable platform to approve and complete invoices (platform is very user friendly) and managing vendor contracts through an AI tool

Required Qualifications:

• Extensive experience in healthcare provider credentialing & enrollment as well as at least light billing management
• Credentialing experience must extend beyond working at a health plan and must be co