Abbott

Revenue Cycle Credentialing Specialist

Abbott • $61K — $122K *
Madison, WI 53711In-Person
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Associate's degree in healthcare administration, public health, business administration, or related field; or high school diploma with 2 years relevant experience.
  • 1+ years of experience in contracting in the healthcare industry.
  • Knowledge of public and private Managed Care payers and reimbursement processes.
  • Understanding of contract development, negotiation, and legal/regulatory implications related to payer contracting.
  • Basic Microsoft Office skills, including proficiency in Word, Excel, Access, Outlook, and PowerPoint.

Responsibilities

  • Prepare and maintain credentialing files and reports for all payers and government entities.
  • Expand payor profiles due to mergers and acquisitions and update contractual credentialing requirements.
  • Process and file applications with payors following their specific requirements and address discrepancies.
  • Conduct follow-up actions until payor approval and acceptance is achieved.
  • Track licensure, accreditation, and insurance expiration dates for compliance with agreements.

Benefits

  • Opportunity for professional development in a dynamic field.
  • Collaboration with cross-functional teams including legal and market access.
  • Field-based position promoting autonomy and flexibility.
  • Contribution to improving patient access to critical diagnostic services.
  • Supportive work environment encouraging innovation and teamwork.
Full Job Description
JOB DESCRIPTION:

Position Overview
The Revenue Cycle Contract Credentialing Specialist will facilitate contract implementation by being proactive and reactive, with internal and external parties to ensure the public and private payer contract paperwork and credentialing is in alignment with corporate goals, contracts, and/or regulations. This role is responsible for facilitating and managing the credentialing of contracts for both government and commercial contracts, working closely with market access and the legal contracting teams in developing and maintaining agreements that provide medical providers and patients with access to our assays while aligning with Abbott Cancer Diagnostic's goals and objectives.

This position is field based.

Essential Duties
Include, but are not limited to, the following:

  • Prepare and maintain credentialing files and reports for all payors and government entities.
  • Expand both government and commercial payor profiles to include all lines of business units due to mergers and acquisitions; complete updates required by contracts for credentialing, disclosure, and demographic information.
  • Process and file applications with third party payors according to each payor's individual requirements and addresses discrepancies, as requested, by payors.
  • Conduct all follow up steps until payor approval, completion, and acceptance is obtained.
  • Update NPI records according to provider specifications.
  • Enroll provider in Medicare/Medicaid as prescribed by each program's requirements.
  • Track licensure, accreditation, and insurance certificate expiration dates to ensure timely processing to be compliant with mandates for contractual agreements with state and federal regulations with payors.
  • Complete requests for re-credentialing for payors, commercial, and government entities.
  • Accept and process all requests from payers for credentialing information, updates, and new contracts and assays.
  • Answer questions, inquiries, and process requests from all internal and external stakeholders related to credentialing information.
  • Enroll all business units in Medicare/Medicaid programs.
  • Address enrollment deficiencies and payor issues regarding commercial and government entities.
  • Assist with electronic funds transfer (EFT) and electronic data interchange (EDI) enrollment, tracking, and filing.
  • Serve as liaison between parent subsidiaries, third party billing agents, payors, commercial, Government entities, and all stakeholders to ensure revenue/reimbursement pull through.
  • Maintain historical data and files.
  • Interface with multiple departments to provide updates and stay abreast of current initiatives that could affect credentialing and enrollment.
  • Monitor incoming emails for Odxclaimsupport, Payor Credentialing, GovTeam, ManagedCareContracts, Contact ManagedCare, and CommercialOpsFax.
  • Effective communication skills, both written and oral, across internal and external stakeholders.
  • Promote an open, collaborative environment built on trust to foster positive teamwork.
  • Apply strong attention to detail, organizational, and analytical skills.
  • Ability to prioritize and manage several projects at once and drive to results with a high emphasis on quality.
  • Ability to influence without authority.
  • Ability to identify and implement enhancement opportunities.
  • Ability to integrate and apply feedback in a professional manner.
  • Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
  • Support and comply with the company's Quality Management System policies and procedures.
  • Regular and reliable attendance.
  • Ability to act with an inclusion mindset and model these behaviors for the organization.
  • Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
  • Ability to work on a computer and phone simultaneously.


Minimum Qualifications
  • Associates degree in healthcare administration, public health, business administration, or related field; or high school degree/general education diploma and 2 years of relevant experience in lieu of Associates degree.
  • 1+ years of contracting experience within the healthcare industry.
  • Demonstrated knowledge of public and private Managed Care payers and reimbursement processes.
  • Demonstrated understanding of market-related issues, contract development, negotiation, and pull through, as well as the legal and regulatory implications associated with private and government payer contracting.
  • Basic knowledge of Microsoft Office; including Word, Excel, Access, Outlook, and PowerPoint.
  • Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
  • Authorization to work in the United States without sponsorship.


Preferred Qualifications
  • 3+ years of contracting experience within the healthcare industry.


The base pay for this position is
$61,300.00 - $122,700.00
In specific locations, the pay range may vary from the range posted.

JOB FAMILY:
Market Access

DIVISION:
ONCO Cancer Diagnostics

LOCATION:
United States > Madison : 1 Exact Lane

ADDITIONAL LOCATIONS:

WORK SHIFT:
Standard

TRAVEL:
No

MEDICAL SURVEILLANCE:
No

SIGNIFICANT WORK ACTIVITIES:
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day), Keyboard use (greater or equal to 50% of the workday)

About Abbott

Abbott Careers

Joining Abbott means becoming part of a globally diverse team dedicated to making a lasting impact on human health. As a leader in healthcare innovation, Abbott provides a dynamic workplace where careers flourish through growth, leadership, and diversity training.

Opportunities at Abbott

Explore a world of opportunities with our team. Whether you're seeking job opportunities in engineering, marketing, research, or healthcare, Abbott offers a variety of positions that allow professionals to grow their careers. Our commitment to diversity and innovation is evident in every aspect of our work, fostering an inclusive culture that values each team member's contribution.

Work You'll Do

At Abbott, every role contributes to our mission of helping people live fuller lives through better health. From groundbreaking research in medical devices to advancements in pharmaceuticals, our team is at the forefront of healthcare innovation. By joining Abbott, you are not just accepting a job; you are embarking on a path of professional and personal growth.

Internship Programs

Kickstart your career with an Abbott internship. Our programs provide invaluable industry experience and a chance to develop essential skills in a real-world setting. Interns at Abbott work on projects that matter, gaining the experience and knowledge necessary to succeed in their future careers.

Professional Development

Abbott is dedicated to the continuous professional development of its employees. With access to cutting-edge technology, leadership programs, and diversity training, our team members are equipped to lead and innovate within the healthcare industry. We support your career journey with robust training programs, mentorship, and opportunities for networking and professional growth.

Benefits and Culture

Our employees enjoy comprehensive benefits designed to support their life and well-being. From health insurance to retirement plans, we ensure our team has everything they need to thrive. Abbott's culture is built on a foundation of respect and integrity, united by a shared commitment to improving health outcomes.

Join Our Team

Discover the impact you can make with a career at Abbott. We are hiring individuals who are passionate, curious, and driven to lead. Search open positions that match your skills and interests on our Jobs page. Prepare your resume, sharpen your interview skills, and get ready to join a team that's at the cutting edge of healthcare solutions.

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Keep up to date with career tips, industry insights, and company news—all from the people who work here. Subscribe to our Careers Blog and personalize your subscription to receive job alerts and insider tips tailored to your preferences.

Explore Abbott

With a commitment to improving life through innovation, leadership, and diversity, Abbott is a place where you can fulfill your potential. See what exciting and rewarding opportunities await at Abbott by exploring our career opportunities today.

SEARCH ABBOTT JOBS

Join us in our mission to make the world a healthier place through innovation, leadership, and diversity. Your journey to a fulfilling career at Abbott starts here.
Learn more about Abbott
Size
113,000 employees
Market Cap
$189 billion
Industry
Healthcare
Net Income
$4.4 billion
Founded
1944
5 Year Trend
+15.6%
Revenue
$34.6 billion
NASDAQ
ABT
* Ladders Estimates

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