921 Credentialing Jobs - Page 36

Role & Responsibilities :- Claims Management : Follow up on outstanding claims to reduce the accounts receivable (AR) days and resolve claim issues in a timely manner. Denial Management : Handle denials by understanding the root cause, correcting errors, and re-submitting claims for processing. Communication : Effectively communicate with insurance companies, healthcare providers, and other stakeholders regarding claims status, denials, appeals, and payment discrepancies. Account Follow-up : Monitor and review AR aging reports to identify and prioritize unpaid claims for follow-up. Oversee credentialing processes, ensuring compliance with industry and regulatory standards. Collect, review, and verify documentation such as licenses, certifications, and work history. Maintain and update credentialing databases with accurate and current provider information. Track credentialing status, expirations, and re-credentialing timelines using software tools. Act as the primary contact for healthcare providers, guiding them through the credentialing process. Perks and benefits Work from Office (Pune) PF Deductions Gratuity Health Insurance Kindly share your resume on guddan@rsystems.com or ping me at 7011037919 for more details. Note: Looking for the immediate Joiner

Oversee complete credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and ongoing monitoring Compliance with accreditation bodies, government regulations, payer requirements, and organizational policies Required Candidate profile Exp in CAQH, PECOS Exp in Medicare, Medicaid, and Commercial insurance enrolment Maintain accurate records and databases of healthcare providers Good in filling insurance enrollment applications

Role & responsibilities Preferred candidate profile

Min 1y exp as an QA to apply for Quality role. Min 1 to 5+ yrs of experience as an AR caller denial management to apply for AR Caller role. Work from Office Required Candidate profile Immediate Joiners are preferred 2-Way Cab Facility Food provided Health insurance Job Location : Bangalore @ Chennai Email: manijob7@gmail.com Call or Whatsapp 9989051577

Contact insurance companies for further explanation of denials & underpayments Should have experience working with Multiple Denials. Take appropriate action on claims to guarantee resolution. Ensure accurate & timely follow up where required. Required Candidate profile Immediate Joiners are preferred Should have worked on appeals, AR Follow-up, refiling & denial management Job Location: Mysore, Bangalore Chennai Email: manijob7@gmail.com Call or Whatsapp 9989051577

EXECUTIVE - PROVIDER NETWORK Job Summary: We are looking to onboard a key person in our Provider Network team, who can bring in hustle and problem-solving attitude to help build Plunes into a formidable company. Ultimately, you will be responsible for managing the process of selecting, credentialing, and onboarding hospitals into our healthcare network. The key person plays a crucial role in maintaining a robust and high-quality network across India. Key Responsibilities: Empanelment of hospitals after detailed study and impact analysis. Negotiate contracts and terms with healthcare facilities to ensure that services, pricing, and quality meet the requirements of the organization. Develop and implement the organization’s business development strategy in line with its goals and objectives. Conduct market research to identify new business opportunities, emerging trends, and competitive landscapes. Analyse market data and industry trends to forecast potential growth areas and adjust strategies accordingly. Collaborate with the executive team to define business development goals and objectives. Build and maintain a strong network of industry contacts and strategic partnerships. Lead negotiations and contract discussions with potential clients, ensuring mutually beneficial agreements are reached. Cultivate and maintain long-term relationships with key clients, partners, and stakeholders. Collaborate with the marketing and sales teams to develop effective strategies for client retention and growth. Determine key business development KPIs. Qualifications: Bachelor's degree in business administration, healthcare administration, or a related field. Proven 3-4 years of experience in network management, credentialing, or a similar role. Knowledge of relevant regulations and accreditation standards. Strong organizational and project management skills. Excellent communication and interpersonal skills. Experience working in a healthcare or insurance setting. Job Type: Full-time Benefits: Provident Fund Schedule: Day shift Experience: Provider Networking: 2 years (Required) Location: Ahmedabad, Gujarat (Required) Willingness to travel: 50% (Required) Work Location: In person

Senior Healthcare RecruiterLocation: Hyderabad, IndiaEmployment Type: Full-time | On-site Job Summary:We are looking for an experienced and driven Senior Healthcare Recruiter to lead sourcing, hiring, and onboarding efforts for a wide range of healthcare consultant roles. The ideal candidate will have deep expertise in healthcare staffing, strong networking capabilities, and a strategic approach to fulfilling both volume and niche healthcare positions. Key Responsibilities:Lead full-cycle recruitment efforts for a variety of healthcare roles, including Medical Assistants, Registered Nurses, Phlebotomists, Licensed Therapists, Dental Hygienists, and Physicians.Partner closely with healthcare clients and internal teams to understand staffing needs and workforce planning.Develop and execute innovative sourcing strategies across multiple platforms (job boards, LinkedIn, healthcare-specific networks, referrals, etc.).Screen, interview, and recommend candidates who meet role-specific qualifications and licensing requirements.Oversee credentialing and compliance processes for healthcare consultants (license verification, background checks, certifications).Mentor and guide junior recruiters and recruitment coordinators in healthcare sourcing best practices.Build and maintain strong pipelines of passive and active healthcare talent for future hiring needs.Generate regular recruitment reports, analytics, and updates for leadership and client teams.Ensure an exceptional candidate experience and maintain strong employer branding in the healthcare market. Required Skills and Qualifications:Bachelor’s degree in Human Resources, Healthcare Administration, Business, or a related field.5–8 years of healthcare recruiting experience, including consultant hiring (permanent, contract, or PRN staff).In-depth knowledge of healthcare job roles, licenses, certifications, and compliance (RN, MA, Therapist, MD, etc.).Experience working with Applicant Tracking Systems (ATS) and VMS/MSP platforms.Strong relationship-building and client management skills.Excellent communication, negotiation, and decision-making abilities.Ability to prioritize and manage high-volume requisitions while maintaining quality.Strategic thinker with a results-driven approach. Preferred:Experience recruiting for U.S.-based healthcare roles and understanding of U.S. healthcare regulations (HIPAA, credentialing standards, etc.).Prior experience in a staffing agency or healthcare consulting environment preferred.

Monitoring & Evaluation Expert Location: Raipur, Chhattisgarh Work Type: Full Time Employment Contract in a Work from Office set up APPLY HERE Information Links www.educategirls.ngo Founder Safeena’s TED Talk , April 2019 2023 WISE Prize in Education Worlds First Development Impact Bond in Education First TED Audacious Project to be chosen from Asia Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence Job Description | Monitoring & Evaluation Expert (Consultant) About Educate Girls: Established in 2007, Educate Girls’ is a non-profit that focusses on mobilizing communities for girls’ education in India’s rural and educationally backward areas. Educate Girls’ scalable, replicable and sustainable program model resides on top of India’s ‘Right to Education Act’. From a 500-schools pilot in 2007, Educate Girls has metamorphosed into a 24,000+ schools, over 18,000 villages across more than 33 districts in the states Rajasthan, Madhya Pradesh, Uttar Pradesh & Bihar. Since inception, Educate Girls has enrolled 1.4+ million Out-of-school girls (OOSG); 1.9+ million children have benefitted from the remedial learning curriculum. Over 18.6 million total beneficiaries have been impacted from Educate Girls’ program model. For more information log on to www.educategirls.ngo In the next 10 years, Educate Girls aims to build one of the largest second-chance program - Project Pragati - for adolescent girls and young women. The objective of Pragati is to create an ecosystem to enable 10th grade credentialing and access to better life chances for adolescent girls and women who have dropped out of the formal school-system. The goal is to transform 10 million lives in the next 10 years. For more information about the project, visit https://www.educategirls.ngo/project-pragati/ Role Overview: The Monitoring Expert is expected to Monitoring, analyzing data collected from Google forms & various other mediums that help EG & dept. of secondary education to maximize its impact. This role will be instrumental in understanding the trends and developing monitoring and evaluation tools. In this role, you will be responsible for: Set up simple systems to manage information/data generated by PMU initiatives and government databases. Conduct simple Data analysis and present and disseminate information to inform programme management/Government nodal officers. Support coordination of needs assessments, ensuring assessment findings are documented and include an analysis of children’s education needs. Lead development of Educate Girls' programme baseline surveys where required. Design, implement performances of schemes by the department Monitoring, analyzing data collected from Google forms & various other mediums for Dept. of Secondary education. Understanding of Government data sources and Analysis UDise data Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence Job Description | Monitoring & Evaluation Expert (Consultant) Interpret data, analyzing results and trends, using statistical techniques where appropriate Generate high quality formal analytical reports on key program delivery outcomes such as Enrolment, Retention and Learning, as per defined calendar Conduct periodic data quality assessments through pattern and outlier analysis Develop dashboards as per requirements Analyze the data for inaccuracies and outliers and highlight possible risks in reporting that data Build efficient and well documented methods for easy, repeatable extraction Provide training to the users in case of any new development/update of the technological solutions Apply if you have: Bachelor’s Degree in a relevant data science field or a related field of study. Minimum 3 years of relevant work experience data analytics/data visualization/ data management Basic to intermediate level of SQL programming experience and demonstrated ability to design and analyze data in relational databases. Experience with PostgreSQL desirable. At least 1-2 years’ experience in data manipulation/cleaning using basic to intermediate Python and/or R. Attributes to be successful in this role at Educate Girls: Design Survey, Demonstrated analytical and assessment skills of quantitative and qualitative data. Intermediate to advanced proficiency in Excel required, especially in visualization. Basic to intermediate skills in SQL and R / Python. Strong skills in data analysis and reporting. Strong skills in Microsoft Office tools such as Word, Excel, and PowerPoint. Visio knowledge desirable. Knowledge of statistical analysis software (such as SAS, SPSS, Tableau) and experience with Tableau software would be a bonus. Demonstrated experience in dashboard design & development. Experience with Google Data Studio desirable. Excellent oral and written presentation skills. APPLY HERE "Educate Girls is committed to achieving 50/50 gender balance in its staff. Female candidates are strongly encouraged to apply for this position." Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence

Job Description – Program Coordinator Designation Program Coordinator Department Operations Location Madhya Pradesh Employment Type Renewable Full Time Employment Contract Report To Manager Partnership - Operations Positions reporting to this role NA Organization Background Established in 2007, Educate Girls’ is a non-profit that focuses on mobilizing communities for girls’ education in India’s rural and educationally backward areas. Strongly aligned with the ‘Right to Education Act’ or the ‘Samagra Shiksha’, Educate Girls is committed to the Government’ vision to improve access to secondary education for adolescent girls and women. For further details about organization, please visit www.educategirls.ngo About the Project Project Pragati is a ‘second chance’ program, launched in 2021, to create a self- sustaining ecosystem at scale for permanently at-risk, out-of-school adolescent girls and young women to enable: 10th-grade credentialing Link them to higher education, employment or vocational training Scope of work: A] Operational Management: Collaborate with the Manager – Partnerships to design and implement training and camp execution plans. Translate the overall program plan into district-specific actionable strategies. Support the Manager – Partnerships in tracking, maintaining, and reviewing weekly and monthly progress reports. Develop district-wise implementation maps, aligning each Implementing Partner’s progress with their assigned personnel. Monitor program implementation, flag potential issues, and provide timely inputs and guidance to partners as needed. Liaise with functional experts to seek specialized support where necessary. Oversee quality assurance processes across all districts managed by Implementing Partners, in line with program standards. Ensure timely sharing of weekly and monthly progress updates with all Implementing Partners. Maintain effective internal and external communication to support smooth operations. B] Training Planning, Coordination and implementation: Collaborate with the State Program Senior Specialist and Implementing Partners to develop a comprehensive training schedule for Prerak’s. Actively engage in Core Group trainings and ensure high-quality delivery of training sessions to Master Trainers from Implementing Partners. Oversee the execution of training programs and monitor their effectiveness on the ground. Address challenges proactively by providing timely support and solutions. Implement and manage a training feedback mechanism to continuously improve training content and delivery methods. Conduct regular field visits aligned with the training plan to offer constructive feedback and guidance to Master Trainers. Coordinate with the program content team for effective planning and negotiation of training components. Design and support capacity-building initiatives to strengthen field implementation teams. Minimum Qualifications, Experience, and Competencies: 1. Graduate degree with 2–3 years of experience in managing field-level operations. 2. Strong command of Hindi (reading, writing, and speaking); working proficiency in English is an added advantage. 3. Proven ability in people management, planning, and effective execution of activities. 4. Sharp observational skills coupled with strong analytical thinking. 5. Hands-on experience in designing and facilitating training sessions. 6. Strong community engagement and networking skills. 7. Excellent problem-solving skills with a resilient, solution-oriented mindset. 8. Comfortable using digital tools and technology for data tracking and reporting. 9. Highly organized and committed to maintaining high standards of professionalism and work ethics. 10. Proficient in MS Office, Gmail, and commonly used internet tools and platforms. Apply if you have 1. Exceptional planning and organizational abilities, with keen attention to detail. 2. Strong analytical thinking and a proactive approach to problem-solving. 3. Effective task management skills, along with excellent time management and communication abilities to work seamlessly across teams & Implementing Partners. 4. The capacity to work both independently and collaboratively in a fast-moving, evolving environment. 5. A deep passion for girls' education and a strong commitment to creating positive change in the lives of girls from

Job Title: Credentialing Manager – Revenue Cycle Management (RCM) Job Summary: We are seeking a highly motivated and experienced Credentialing Manager with 10+ years of experience in Revenue Cycle Management (RCM). This role is critical to ensuring that healthcare providers are properly credentialed, enrolled, and compliant with all regulatory and payer requirements. The ideal candidate will have a strong understanding of credentialing processes, healthcare regulations, payer requirements, and effective team management skills. Key Responsibilities: Manage the end-to-end credentialing process, including initial credentialing, re-credentialing, and enrollment for healthcare providers with insurance payers, Medicare, Medicaid, and other entities. Ensure timely and accurate submission of credentialing applications, supporting documentation, and follow-ups. Monitor credentialing and re-credentialing timelines to avoid gaps in provider eligibility. Maintain compliance with all regulatory, legal, and payer-specific requirements related to credentialing and enrollment.. Conduct periodic audits to ensure accuracy and completeness of credentialing records. Lead, mentor, and manage a team of credentialing specialists to achieve departmental goals. Provide training and guidance on credentialing policies, processes, and best practices. Monitor team performance and implement strategies for continuous improvement. Act as the primary liaison between healthcare providers, payers, and internal stakeholders regarding credentialing and enrollment issues. Resolve provider enrollment issues and escalate concerns as necessary. Communicate updates and changes in credentialing policies and payer requirements to relevant parties. Maintain accurate and up-to-date credentialing records in the credentialing software or database. Generate and present reports on credentialing status, key performance indicators (KPIs), and compliance metrics. * Experience: Minimum of 10 years of experience in credentialing within the Revenue Cycle Management (RCM) or healthcare industry, with at least 2 years in a leadership or management role. Skills: Strong knowledge of credentialing and enrolment processes, payer requirements, and healthcare regulations. Proficiency in credentialing software and systems. Excellent organizational, problem-solving, and multitasking abilities. Strong leadership and team management skills. Effective verbal and written communication skills. Preferred Qualifications: Certification in credentialing (e.g., CPCS or CPMSM) is highly desirable. Experience with RCM operations and understanding of the healthcare revenue cycle. Familiarity with HIPAA, NCQA, and other accreditation standards. Job Type: Full-time Benefits: Food provided Provident Fund Schedule: Monday to Friday Night shift US shift Experience: credentialing: 10 years (Required) Location: Chandigarh, Chandigarh (Required) Work Location: In person

Program Man ager Network Rajasthan Department: Operations Location: Pali-Rajasthan Information Links www.educategirls.ngo Founder Safeena’s TED Talk , April 2019 2023 WISE Prize in Education Worlds First Development Impact Bond in Education First TED Audacious Project to be chosen from Asia Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence Job Description | Program Manager Network About Educate Girls: Established in 2007, Educate Girls’ is a non-profit that focusses on mobilizing communities for girls’ education in India’s rural and educationally backward areas. Educate Girls’ scalable, replicable and sustainable program model resides on top of India’s ‘Right to Education Act’. From a 500-schools pilot in 2007, Educate Girls has metamorphosed into a 24,000+ schools, over 18,000 villages across more than 33 districts in the states Rajasthan, Madhya Pradesh, Uttar Pradesh & Bihar. Since inception, Educate Girls has enrolled 1.4+ million Out-of-school girls (OOSG); 1.9+ million children have benefitted from the remedial learning curriculum. Over 18.6 million total beneficiaries have been impacted from Educate Girls’ program model. For more information log on to www.educategirls.ngo In the next 10 years, Educate Girls aims to build one of the largest second-chance program - Pragati - for adolescent girls and young women. The objective of Pragati is to create an ecosystem to enable 10th grade credentialing and access to better life chances for adolescent girls and women who have dropped out of the formal school-system. The goal is to transform 10 million lives in the next 10 years. For more information about the project, visit https://www.educategirls.ngo/project-pragati/ Role Overview : We are seeking an enthusiastic and results-driven Program Manager Network to spearhead the delivery of Project Pragati in Rajasthan to enable more than 15,000 adolescent girls and young women to pass their 10th grade from Rajasthan State Open School in the next 21-24 months. As a Program Manager Network, you will be the driving force behind the successful execution of this life- changing initiative. This is not just another job; it's a unique chance to be part of a team that is actively changing lives through transformation in education. In this role, you will be responsible for: Scope of work: A] Support Operations Strategy & Approach Designing operations strategy with Program Lead Pragati and creating an action plan with specific inputs from the district. Creating the project dashboard for the district in line with organization expectations and actual situation of the district. Co-design actionable implementation plan for the district with clear timeline and budget targets along with the Program Lead Pragati. Conduct root cause analysis to design solutions for systemic problems and develop innovations for the project effectiveness. Support Program Lead Pragati in adapting program strategy based on on-ground learning from district. Support field Pragati Coordinator and Prerak in implementation of the project as per agreed timelines Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence Job Description | Program Manager Network period-wise and track them for progress. B] On-ground Implementation and Monitoring Ensure Enrolment & Retention targets are completed as per District Targets Ensuring all activities for driving community ownership are carried out as planned. Interact with key stakeholders (government departments and officials) on a day-to-day basis to ensure delivery on project objectives. Ensuring strong working relationships with government officials at district level, project partners (external partner), non-profit partners, school principals and teachers. Review work done by implementation partners, including government officials, to ensure compliance with outcome, budget and timeline targets. Identify operational bottlenecks and weaknesses, wherever applicable. Track project progress on key indicators according to the given framework. Report performance on key indicators periodically and on a timely basis. C] Managerial Responsibility People Capability, ensuring a high-performance culture & minimize people risk. o Reduce attrition within a defined percentage that minimizes impact on operations and achieving targets. o Encourage Gender Diversity initiatives across the employee life-cycle. Effective Utilization of Finance and optimum adherence to compliances for the operational districts o Budget utilization efficiently, monitoring & tracking variances. o Adherence to Policy & Procedures (Finance policy, procurement policy, ALM and any other process set from time to time) o Donor Reporting o Statutory Audits o Internal Audits o Donor Audits / Visits Establish linkages and strengthen networking and liaison with government departments and other stakeholders to foster support for effective implementation of the project deliverables. Ensuring Procurement of goods and services are done as per the procurement policy of the organization and in close collaboration with Procurement Team IT Budget Planning for respective office Preparing Functional Requirement for IT Strategy Providing feedback and input for IT Strategy Ensure confidentiality and security of the project data and information. D] Communication and Documentation Documentation and communication of project achievements / outcomes in a timely and as per approved format. Ensure submission of periodical reports (programmatic and financial) as per organization requirements and donor specifications Preparing and managing documentation related to project e.g., approvals, letters, etc. Oversee the data collection and analysis in relation to programmatic intervention areas. Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence Job Description | Program Manager Network Documentation on on-ground learnings and knowledge received from external partner to support EG’s internal capacity / knowledge building. Submit reports and participate in state and district level reviews periodically as per project requirement, Develop and share all periodic progress reports in a timely manner. Risk mitigation & conflict management Minimum Qualifications, Experiences and Expectations 1. 5-7 years’ experience in delivering projects, monitoring of Education programs 2. Excellent proficiency in Hindi – to read, write and speak, proficiency in English is preferable 3. Excellent planning and execution skills 4. Good observation and analytical skills 5. Experience in conducting training sessions 6. Analytical and Problem-solving ability, with die hard attitude 7. Familiar with standard project management practices 8. Well organized, with high standards of work ethics 9. Comfortable in using MS Office, Gmail and other standard Internet Resources Apply if you have 1. Excellent planning and organizational skills, with strong attention to detail 2. Strong analytical and problem-solving skills 3. Ability to manage tasks, with strong time management and communication skills, to collaborate across verticals. 4. Ability to work independently and as part of a team in a fast-paced, dynamic environment. 5. Passion for girls' education and a commitment to improving the lives of girls in underprivileged communities. 6. Open to travel to the field when required. APPLY HERE Our Core Values : Integrity | Collaboration | Gender Equality | Empathy | Excellence

We are seeking an experienced and detail-oriented Certification Exam Development Manager to lead the design, development, and maintenance of certification exams that uphold the highest standards of validity, reliability, and fairness. This role is critical in ensuring Oracle industry-recognized professional certifications accurately assess candidate competencies. Career Level - IC3 Responsibilities About Oracle University Oracle University (OU) is committed to providing world-class training and an unbeatable educational experience. OU focuses on delivering superior training that enhances the adoption of Oracle technologies. As one of the largest corporate training organizations in the world, OU helps make technology strategies successful with the help of complete, flexible, and customized learning solutions that are delivered globally. The goal is to provide every OU student with a highly engaging learning experience through a range of learning products and services. Roles and Responsibilities Manage the end-to-end exam development process for Oracle Cloud Applications and Oracle Cloud Infrastructure on Oracle MyLearn and Oracle Cloud Success Navigator platforms Contribute to all aspects of high-impact certification projects from start to finish, working in close collaboration with product development engineering, consultants, partners, instructional designers, psychometricians, and other Subject Matter Experts (SMEs) Define the intent and scope of exams for specific target audiences and job roles Perform Job Task Analysis (JTA), create exam blueprint design Manage item banks, blueprint development, and psychometric analysis to ensure test integrity and performance Conduct item review workshops and training sessions for SMEs and item writers Provide guidance and training on Oracle style guidelines and best practices for item writing Conduct item analysis and review statistical data to improve exam quality Manage multiple projects simultaneously, ensuring timely delivery of high-quality exam content Implement Certification industry standards and best practices in examdeliverables Stay up-to-date with latest trends and best practices in instructional design, certification exam development, and psychometrics Build a strong technical understanding of the product line to effectively engage with consultants, engineering teams, subject matter experts (SMEs), and instructors Own and drive the Go-to-Market strategy to ensure the success of certification exams To be successful in this role, we need someone who has: Experience in conducting Job Task Analysis, facilitating item writing workshops and training SMEs Knowledge of Certification development standards and models Experience in designing and developing exams Exceptional writing, editing, and proofreading skills Understanding of what it takes to produce candidate value in an exam Professionalism and confidence to defend exams, processes, and exam content Strong knowledge of psychometric principles and their application in exam development Excellent project management skills with the ability to manage multiple projects simultaneously Strong analytical skills with the ability to interpret complex data and make data-driven decisions Excellent written and verbal communication skills, with the ability to convey complex concepts clearly to diverse audiences Proven ability to work in a fast-paced environment with geographically distributed stakeholders Basic Qualifications Bachelors degree in Science or Engineering 5+ years of experience in certification exam development or credentialing, preferably in a tech or cloud-based environment Knowledge of certification industry standards and best practices Deep understanding of Oracle Cloud Applications (ERP, HCM, SCM, or CX) or experience working in the Oracle partner/customer ecosystem Previous experience with certification exams as an SME Technical writing and editing experience Any related-industry professional certification credentials Exposure to AI authoring/development tools Qualifications Career Level - IC3

We are pleased to inform you that we are conducting a Walk-in Drive on 23rd August 2025 (Saturday) from 12:00 PM to 4:00 PM at our Bangalore location. • Experience: Minimum 1 to 4 years in AR domain Role: Associate / Senior AR Associates/ Analyst Required Candidate profile Process: Physician Billing or Hospital Billing - Denial Management Voice Priority: High – quality profiles are requested Job Location Bangalore Email: manijob7@gmail.com Call or Whatsapp 9989051577

Job Summary: We are seeking a dedicated and detail-oriented Credentialing Specialist with at least 2 years of experience working in a provider office . The ideal candidate will manage the full lifecycle of provider credentialing and payer enrollment processes to ensure timely billing and revenue recognition within the Revenue Cycle Management (RCM) framework. Key Responsibilities: Manage end-to-end provider credentialing and re-credentialing processes with commercial and government payers. Complete payer enrollment applications for Medicare, Medicaid, and private insurers. Maintain and update provider profiles in CAQH , PECOS , NPPES , and other relevant portals. Liaise with providers to obtain, verify, and validate all required documentation (licenses, certificates, malpractice insurance, etc.). Monitor and track credentialing expirations , license renewals, and re-attestation schedules. Work closely with billing and compliance teams to ensure timely payer setup and claims processing. Maintain accurate and up-to-date records in credentialing databases or software. Ensure compliance with HIPAA , NCQA , JCAHO , and payer-specific standards. Resolve enrollment issues and follow up on pending applications with payers and agencies. Communicate credentialing status to providers, management, and RCM teams. Required Skills & Qualifications: Experience: 2 -4 years of hands-on experience in credentialing from a provider office setting . Strong knowledge of: CAQH, PECOS, NPPES Medicare/Medicaid enrollment Commercial payer requirements and portals (e.g., Availity) Familiarity with RCM and its impact on credentialing. Proficiency in MS Office tools (Excel, Word, Outlook). Excellent verbal and written communication skills. Strong attention to detail and ability to manage multiple tasks. Understanding of credentialing compliance guidelines (HIPAA, NCQA, etc.).

Job Title- Executive - AR ( Credentialing ) Job Description As a Credentialing Associate at R Systems, you will play a pivotal role in ensuring the accurate and timely processing of credentialing applications for US healthcare professionals. Your expertise in regulatory compliance, attention to detail, and ability to manage multiple tasks will be critical in maintaining provider records and ensuring adherence to industry standards. You will conduct thorough background checks, verify licenses and certifications, and collaborate with internal teams to address credentialing issues. Additionally, you will stay informed about changes in healthcare regulations and help refine credentialing policies and procedures to enhance operational efficiency. Your contribution will directly impact the quality of healthcare services by ensuring that only qualified professionals are credentialed. Roles & Responsibilities Oversee credentialing processes, ensuring compliance with industry and regulatory standards. Collect, review, and verify documentation such as licenses, certifications, and work history. Maintain and update credentialing databases with accurate and current provider information. Track credentialing status, expirations, and re-credentialing timelines using software tools. Act as the primary contact for healthcare providers, guiding them through the credentialing process. Collaborate with internal teams, including HR and legal, to ensure credentialing requirements are met. Conduct audits to identify areas for improvement and ensure compliance with policies. Prepare detailed reports on credentialing activities and outcomes for leadership review. Stay current with state and federal regulations to ensure compliance. Assist in developing and implementing credentialing policies aligned with best practices and organizational standards. If you have relevant experience please drop your CV at naresh.arya@rsystems.com

Experience: 1-5 years in AR calling (US healthcare) Exp in denial management and handling AR calls Exp with healthcare billing software Ensure accurate & timely follow up where required. Required Candidate profile Immediate Joiners are preferred Should have worked on appeals, AR Follow-up, refiling & denial management Job Location: Noida, Bangalore Chennai Email: manijob7@gmail.com Call or Whatsapp 9989051577

Designation: AR Caller / Senior AR Caller Experience: Minimum 1 years Strong understanding of UB04 claim forms and related processes Required Candidate profile Notice Period: Immediate joiners or candidates with a maximum 15-day notice period are highly preferred. Job Location Bangalore Email: manijob7@gmail.com Call or Whatsapp 9989051577

Job Title: Team Leader Credentialing Department: US Healthcare Operations Location: Noida Experience Required: 6–10 Years Employment Type: Full-Time Job Summary: We are seeking a dynamic and experienced Team Leader – Credentialing to oversee and manage a credentialing team within the US healthcare domain. The ideal candidate will be responsible for ensuring timely and accurate provider enrollment, re-credentialing, and compliance with payer and regulatory standards. This role demands strong leadership, process optimization, and stakeholder management skills to maintain high levels of quality and client satisfaction. Responsibilities: Lead and supervise daily operations of the credentialing team, ensuring adherence to client, payer, and regulatory guidelines. Manage end-to-end provider enrollment and re-credentialing processes with insurance networks, hospitals, and healthcare facilities. Review provider documentation for accuracy, completeness, and compliance prior to submission. Monitor turnaround times and ensure timely completion of credentialing tasks. Serve as the primary escalation point for complex credentialing issues, collaborating with payers and providers for resolution. Train, mentor, and evaluate team members to uphold quality standards and meet productivity goals. Generate and analyze reports on credentialing status, performance metrics, and compliance indicators. Coordinate with internal departments, clients, and third-party entities to streamline credentialing workflows. Stay updated on payer policies, NCQA standards, and healthcare compliance regulations. Identify and implement process improvements to enhance operational efficiency and client satisfaction. Mandatory Skills: Strong expertise in Credentialing , Provider Enrollment , and US Healthcare Regulations Proven leadership and team management capabilities Excellent communication and problem-solving skills Proficiency in credentialing software and reporting tools

Greetings from E-care India Pvt Ltd!!! We are looking for Experienced AR Callers!! Designation: Executive AR Caller / Senior AR Caller. Job Responsibilities: - Min of 1 Year to 4 years into AR calling experience is required. - Knowledge into Healthcare concept is mandatory. - Knowledge on Denial management. - Good communication skills. - Understand the client requirements and specifications of the project. Job Benefits: - Joining Bonus - Attractive Attendance and performance incentives. - Free one-way cab drop facility for all employee and home drop for women employees - Fixed Week off. - Medical Insurance will be covered. - Free refreshments will be provided. - Reward & Recognition practice. Interested and Suitable candidates can send your resume through WhatsApp along with the below mentioned information @ 9025895226 HR : Thanigesh Name: Position applying for: AR Calling Current company: Current Salary: Expected Salary: Notice period: Current Location: **Note: Mention you're looking for AR calling position in the WhatsApp message along with the updated resume while sending. Interviews will be happening through G-meet only

Job Title- Executive - AR ( Credentialing ) Job Description As a Credentialing Associate at R Systems, you will play a pivotal role in ensuring the accurate and timely processing of credentialing applications for US healthcare professionals. Your expertise in regulatory compliance, attention to detail, and ability to manage multiple tasks will be critical in maintaining provider records and ensuring adherence to industry standards. You will conduct thorough background checks, verify licenses and certifications, and collaborate with internal teams to address credentialing issues. Additionally, you will stay informed about changes in healthcare regulations and help refine credentialing policies and procedures to enhance operational efficiency. Your contribution will directly impact the quality of healthcare services by ensuring that only qualified professionals are credentialed. Roles & Responsibilities Oversee credentialing processes, ensuring compliance with industry and regulatory standards. Collect, review, and verify documentation such as licenses, certifications, and work history. Maintain and update credentialing databases with accurate and current provider information. Track credentialing status, expirations, and re-credentialing timelines using software tools. Act as the primary contact for healthcare providers, guiding them through the credentialing process. Collaborate with internal teams, including HR and legal, to ensure credentialing requirements are met. Conduct audits to identify areas for improvement and ensure compliance with policies. Prepare detailed reports on credentialing activities and outcomes for leadership review. Stay current with state and federal regulations to ensure compliance. Assist in developing and implementing credentialing policies aligned with best practices and organizational standards. Both Side Cabs Night Shift If you have relevant experience please drop your CV at guddan@rsystems.com Whatsapp - 7011037919

Contact insurance companies for further explanation of denials & underpayments Should have experience working with Multiple Denials. Take appropriate action on claims to guarantee resolution. Exp in Hospital billing is must to apply. Required Candidate profile Immediate Joiners are preferred Should have worked on appeals, AR Follow-up, refiling & denial management Job Location: Noida Email: manijob7@gmail.com Call or Whatsapp 9989051577

Position 1: AR Caller / Senior AR Caller Experience: 2 to 5 years Required Skills: Expertise in Hospital Billing (UB04) Strong understanding of UB04 claim forms and related processes Strong in Denial Management Good communication skills Required Candidate profile Notice Period: Immediate joiners or candidates with a maximum 15-day notice period are highly preferred Shift: Night shift only Location: Bangalore Email: manijob7@gmail.com Call / Whatsapp 9989051577

Job Title: Assistant Manager Credentialing Company: Capline Services Location: Noida (On-site) Shift: 24/7 Operations (Rotational Shifts) Work Days: Monday to Friday (Saturday and Sunday Off) Experience: Minimum 6 years in US Healthcare Credentialing, with at least 2 year in a supervisory or assistant manager role Salary: 9 LPA 12 LPA (Based on experience and qualifications) About Capline Services Capline Services is a captive unit providing end-to-end support to US healthcare providers. We specialize in credentialing, revenue cycle management, and healthcare staffing. Job Overview We are seeking an experienced Assistant Manager Credentialing to lead and oversee a credentialing team responsible for provider enrollment, re-credentialing, and regulatory compliance across various US healthcare payers. The ideal candidate will have in-depth credentialing expertise, proven leadership capabilities, and a strong understanding of payer guidelines and compliance standards. Key Responsibilities Oversee the end-to-end credentialing lifecycle including initial credentialing, re-credentialing, and enrollments with Medicare, Medicaid, and commercial payers Lead daily team operations, monitor KPIs, and drive performance improvements Maintain and manage credentialing systems such as CAQH, PECOS, NPPES, Availity, and others Ensure strict compliance with NCQA, URAC, CMS, and payer-specific guidelines Collaborate with internal and external stakeholders to resolve escalations and ensure timely application submissions Conduct training sessions, performance evaluations, and support employee development Provide strategic input to optimize workflows and improve operational efficiency Requirements Bachelors degree preferred Minimum 6 years of experience in US healthcare credentialing, including at least 2 years in a leadership or assistant managerial role Strong understanding of US healthcare regulations and payer enrollment processes Hands-on experience with credentialing portals and tools Excellent team leadership, communication, and analytical skills Ability to work in rotational shifts in a 24/7 operational environment Why Capline? Fixed weekend offs Leadership role in a growing US healthcare captive Supportive, process-driven, and collaborative work culture Opportunities for long-term career advancement To Apply: Please connect at Zakir Husain 9971047487

Key Responsibilities: Credential Verification: Conduct primary source verification of education, licenses, certifications, and work history. Perform background checks including criminal records and disciplinary actions. Compliance & Regulation: Ensure compliance with NCQA, CMS, The Joint Commission, and other regulatory bodies. Monitor expiration dates and initiate timely renewals of credentials. Documentation & Database Management: Maintain accurate records in credentialing software (e.g., CAQH, PECOS, NPPES). Track and update provider profiles and credentialing logs. Communication & Coordination: Liaise with providers, payers, and internal departments to resolve discrepancies. Respond to inquiries and facilitate credentialing-related communication. Audit & Reporting: Prepare for internal and external audits. Generate reports on credentialing status and compliance metrics.

Extensive experience in payment posting. Minimum of 4-5 years of experience in payment posting. Good communication skills both verbal and written. Willing to work in Night Shift. Required Candidate profile Ability to work with numbers and do bank reconciliations Ability to call insurance companies to troubleshoot EOB issues or obtain payment information Call or Whatsapp 9989051577