Credential Callers

1 - 3 years

0 Lacs

chennai

Posted:9 hours ago| Platform: Shine logo

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Skills Required

calling enrollment provider caller patient crediential dental

Work Mode

On-site

Job Type

Full Time

Job Description

A Credentialing Specialist's responsibilities generally include:

    • Application Processing:

       Processing initial applications and re-credentialing paperwork for new and existing staff members.

    • Verification:

       Collecting, reviewing, and verifying credentials such as education, training, residency, licenses, certifications, and work history. This often involves liaising with external agencies, educational institutions, and prior employers.

    • Documentation and Record Keeping:

       Maintaining accurate, current, and confidential digital and physical records/files of all provider credentials in a database.

    • Compliance Monitoring:

       Ensuring all processes and provider information comply with relevant laws, regulations, and standards set by accrediting bodies (e.g., NCQA, The Joint Commission).

 

  • Expiration Tracking:

     Monitoring and tracking the expiration dates of licenses, certifications, and insurance to ensure continuous compliance and timely renewal.

  • Discrepancy Resolution:

     Identifying and investigating any discrepancies or gaps in information provided by the applicant.

  • Communication:

     Communicating with providers, staff, and insurance companies regarding credentialing status, requirements, and policies.

  • Committee Presentation:

     Presenting completed applications to a credentialing committee for final review and approval.

  • Billing Support:

     Ensuring all providers are properly credentialed with insurance companies so that services can be billed accurately and claims processed for maximum reimbursement.     

 

  Key Skills and Qualifications

  • Attention to Detail:

     Essential for reviewing extensive documentation and spotting errors or inconsistencies.

  • Organizational Skills:

     Required to manage multiple provider files and track numerous deadlines and requirements.

  • Communication Skills:

     Strong verbal and written communication skills for interacting with a variety of stakeholders.

  • Knowledge of Regulations:

     Understanding of healthcare compliance regulations and credentialing standards.

  • Technical Skills:

     Proficiency in database management and relevant credentialing or EHR software.

  • Confidentiality:

     Adherence to strict standards of confidentiality due to the sensitive nature of the information handled

 

More Jobs at Source To Win Consultancy Hiring For Arizon

Credential Callers

chennai

1.0 - 3.0 yrs
|

INR 0 - 0 Lacs

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