921 Credentialing Jobs - Page 37

Designation: AR Caller / Senior AR Caller Experience: Minimum 2 years in Hospital billing preferred. 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 / Chennai Email: manijob7@gmail.com Call or Whatsapp 9989051577

Designation : AR Callers / Senior AR Callers Exp: 1 Y to 5 y Required Skills: Expertise in Physician Billing (CMS-1500) Strong understanding of CMS-1500 claim forms and related processes Strong in Denial Management Good communication skills Required Candidate profile Notice Period: Immediate joiners or candidates with a max 7 day notice period are highly preferred Shift : Day Shift Job Location: Bangalore Email:manijob7@gmail.com Call / Whatsapp 9989051577

Position Description: We are seeking a highly skilled and motivated individual to join our healthcare organization as a Medical Credentialing Specialist with a strong background in project management. In this crucial role, you will be responsible for overseeing the credentialing process for healthcare providers, ensuring compliance with industry standards, and optimizing workflow through effective project management strategies. Position Duties : 1. Credentialing Oversight: Manage the end-to-end credentialing process for healthcare providers, including initial applications, re-credentialing, and ongoing monitoring. Stay abreast of industry regulations and accreditation standards to ensure compliance in all credentialing activities. Collaborate with internal departments to gather necessary documentation and information for credentialing purposes. 2. Project Management: Utilize project management methodologies to streamline and enhance the credentialing process. Develop and implement project plans, timelines, and milestones to ensure efficient and timely completion of credentialing tasks. Identify and address bottlenecks in the credentialing workflow through effective project management strategies. 3. Quality Assurance: Conduct regular audits and quality checks to verify the accuracy and completeness of credentialing files. Implement continuous improvement initiatives to enhance the efficiency and effectiveness of the credentialing process. 4. Communication and Collaboration: Communicate effectively with healthcare providers, internal staff, and external organizations to gather necessary information and resolve credentialing issues. Collaborate with cross-functional teams to integrate credentialing processes seamlessly with other organizational functions. Position Requirements: 1. Education and Certification: Bachelor's degree in healthcare administration, business, or related field. Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) certification is preferred. 2. Experience: Minimum of 3 years of experience in medical credentialing. Proven track record in project management, with experience in developing and implementing project plans. 3. Knowledge and Skills: In-depth understanding of credentialing standards, regulations, and best practices. Strong project management skills with the ability to manage multiple projects simultaneously. Excellent organizational and analytical skills, with attention to detail. 4. Communication Skills: Exceptional written and verbal communication skills. Ability to effectively communicate with internal and external stakeholders. 5. Technology Proficiency: Proficient in using credentialing software and Microsoft Office Suite. 6. Adaptability: Ability to adapt to changes in regulations and industry standards. Willingness to embrace new technologies and methodologies for process improvement.

Position Description: We are seeking a highly skilled and motivated individual to join our healthcare organization as a Medical Credentialing Specialist with a strong background in project management. In this crucial role, you will be responsible for overseeing the credentialing process for healthcare providers, ensuring compliance with industry standards, and optimizing workflow through effective project management strategies. Position Duties : 1. Credentialing Oversight: Manage the end-to-end credentialing process for healthcare providers, including initial applications, re-credentialing, and ongoing monitoring. Stay abreast of industry regulations and accreditation standards to ensure compliance in all credentialing activities. Collaborate with internal departments to gather necessary documentation and information for credentialing purposes. 2. Project Management: Utilize project management methodologies to streamline and enhance the credentialing process. Develop and implement project plans, timelines, and milestones to ensure efficient and timely completion of credentialing tasks. Identify and address bottlenecks in the credentialing workflow through effective project management strategies. 3. Quality Assurance: Conduct regular audits and quality checks to verify the accuracy and completeness of credentialing files. Implement continuous improvement initiatives to enhance the efficiency and effectiveness of the credentialing process. 4. Communication and Collaboration: Communicate effectively with healthcare providers, internal staff, and external organizations to gather necessary information and resolve credentialing issues. Collaborate with cross-functional teams to integrate credentialing processes seamlessly with other organizational functions. Position Requirements: 1. Education and Certification: Bachelor's degree in healthcare administration, business, or related field. Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) certification is preferred. 2. Experience: Minimum of 3 years of experience in medical credentialing. Proven track record in project management, with experience in developing and implementing project plans. 3. Knowledge and Skills: In-depth understanding of credentialing standards, regulations, and best practices. Strong project management skills with the ability to manage multiple projects simultaneously. Excellent organizational and analytical skills, with attention to detail. 4. Communication Skills: Exceptional written and verbal communication skills. Ability to effectively communicate with internal and external stakeholders. 5. Technology Proficiency: Proficient in using credentialing software and Microsoft Office Suite. 6. Adaptability: Ability to adapt to changes in regulations and industry standards. Willingness to embrace new technologies and methodologies for process improvement.

Role & responsibilities Candidate should have indepth knowledge on the payer enrollment process. Payer enrollment for Medicare, Medicaid, and commercial insurers Managing contracts and participation agreements Knowledge of healthcare laws, payer policies, and revalidation requirements Insights on the waystar clearing house is an added advantage

Role & responsibilities Candidate should have indepth knowledge on the payer enrollment process. Payer enrollment for Medicare, Medicaid, and commercial insurers Managing contracts and participation agreements Knowledge of healthcare laws, payer policies, and revalidation requirements Insights on the waystar clearing house is an added advantage

Join Our Growing US Healthcare Team as a Credentialing Coordinator! Are you detail-obsessed, process-driven, and ready to be the bridge between healthcare providers and payers? This is your chance to shine in a role where accuracy saves time, and time saves lives. Location: Noida (Within a 30 km radius) Experience: 24 years in US healthcare credentialing (Provider Enrollment, CAQH, NPI, and Payer Applications) Education: Any Graduate (Healthcare background preferred) What Youll Do: Manage end-to-end credentialing for US healthcare providers — from initial application to final approval. Maintain CAQH profiles, NPIs, and state license verifications with zero lapses. Work with payers, provider groups, and internal teams to ensure on-time enrollments . Track, update, and troubleshoot applications until closure. Maintain an organized, up-to-date credentialing database. What Makes You a Great Fit: You’re a master of follow-ups — “no update” is never an answer. You can spot a missing document from a mile away. You speak fluent credentialing lingo (CAQH, PECOS, NPI, DEA— no need for Google). You’re comfortable juggling multiple provider files without losing track. Proficiency in MS Office and excellent communication skills are a must. Why Join Us? Work with a supportive, people-first team that values your expertise. Be part of a fast-growing US healthcare process with real career growth. Enjoy a collaborative environment where your work directly impacts patient care delivery . How to Apply: Apply now — because credentialing waits for no one!

1. Job Role: Sr. Credentialing Executive Experience: 2 - 4 years Shift Time: Night Required Skills: *Prepare and process credentialing applications. *Ability to perform in-depth research to determine the correct action needed. *Ensure validating panel availability and work on any deficiencies are addressed within a timely manner. *Maintain up to date records and log(s) by checking application status online or over the phone. *Timely follow-up on submitted applications via phone call/email with the payer for approval *Develop SOPs/ process documents to ensure seamless KT when required 2. Job Role: Credentialing - Quality Analyst Experience: 5 - 7 years Shift Time: Night Required Skills: *QA should have experience in Online & Offline payer application (Medicare, Medicaid & Commercial) and to validate the status till approval. Skills to audit online applications. *QA should have experience in payer connect (to obtain status, initial verification and ability to resolve complex scenarios) *Experience in insurance guidelines. *Good knowledge in Payer Contract copy, fee schedule negotiation. *Knowledge in Revalidation, Recredentialing and Reenrollment *Handle credentialing related denials (AR). Contact Details: Sharmila/Joshua Call: 9240258183/ 9240258187 WhatsApp: 9840966922/ 9600707941 Email: recruitment@asprcmsolutions.com

Provider Credentialing (US healthcare medical billing) 1. Collect all the data and documents required for filing credentialing applications from the physicians 2. Store the documents centrally on our secure document management systems 3. Understand the top payers to which the practice sends claim and initiate contact with the payers 4. Apply the payer-specific formats after a due audit 5. Timely follow-up with the Payer to track application status 6. Obtain the enrolment number from the Payer and communicate the state of the application to the physician 7. Periodic updates of the document library for credentialing purposes. Required Candidate profile Desired Candidate Profile: 1. Should have worked as a Credentialing Analyst for at least 3-year medical billing service providers 2. Good Knowledge in Provider credentialing (Doctor side). 3. Good knowledge in clearing house setup - Electronic Data Interchange setup (EDI) - Electronic Remittance Advice Setup (ERA) - Establish Insurance Portals (EFT) 4. Experience in Insurance calling. 5. Good knowledge in filling insurance enrollment applications. 6. Good experience in CAQH, PECOS application. 7. Experience in Medicare, Medicaid, Commercial insurance enrollment. 8. Positive attitude to solve problems 9. Knowledge of generating aging report 10. Strong communication skills with a neutral accent Note: Minimum of 8 to 12 years of Provider Credentialing experience must. Location: Coimbatore (Onsite job) Preference will be given to candidates who can start immediately or with short notice. Candidates who are freshers or have experience in other domains are kindly requested not to apply for this position.

Overview The Team Lead, Provider Enrollment plays a key leadership role in the Provider Enrollment department, acting as a mentor, subject matter expert, and operational resource for a team of enrollment specialists. This role supports the Supervisor and Manager by overseeing daily workflows, resolving escalated issues, and ensuring enrollment tasks are completed accurately and in a timely manner. The Team Lead works collaboratively across internal teams and with external payers to support efficient provider onboarding and compliance with payer requirements. Responsibilities Lead, mentor, and support a team of Provider Enrollment Specialists in their daily tasks and development. Assist with onboarding and training new team members; develop and maintain training materials and SOPs. Monitor daily workload queues to ensure timely completion of enrollment tasks and proper case prioritization. Serve as the first point of escalation for complex enrollment issues or payer communication delays. Perform advanced follow-up with CMS, Medicaid, and third-party payers to resolve issues and ensure timely application processing. Ensure the accurate submission, tracking, and follow-up of CMS Medicare, State Medicaid, and commercial payer applications. Audit provider enrollment records and documentation to ensure compliance with internal standards and external payer requirements. Partner with clients, market locations, operations personnel, and revenue cycle stakeholders to facilitate smooth provider onboarding and ongoing maintenance. Proactively manage payer revalidation schedules and ensure timely renewals to prevent lapses in enrollment or deactivation. Track and maintain documentation of enrollment activities in all applicable systems. Maintain up-to-date knowledge of payer rules, credentialing requirements, and regulatory changes impacting provider enrollment. Contribute to process improvement initiatives and help drive efficiency across the team. Perform special projects and other duties as assigned. Qualifications High School diploma or equivalent. 2+ years of experience in provider enrollment, credentialing, or payer relations within a healthcare or RCM environment. 1+ year of experience in a lead or supervisory role preferred.

Overview As a US Healthcare Provider Enrollment Quality Assurance Specialist, you will be responsible for ensuring the accuracy, completeness, and compliance of provider enrollment processes within a healthcare organization. You will play a critical role in maintaining high standards of quality and efficiency in provider enrollment activities to support the organization's revenue cycle management. Responsibilities Quality Assurance Oversight: Conduct thorough reviews and audits of provider enrollment applications, documents, and data to ensure accuracy, completeness, and compliance with regulatory requirements, payer policies, and organizational standards. Documentation Verification: Validate and authenticate provider credentials, licenses, certifications, and other required documents submitted during the enrollment process to ensure authenticity and compliance with regulatory and payer requirements. Application Processing: Facilitate the timely and accurate processing of provider enrollment applications, including data entry, verification, and submission to relevant regulatory bodies and insurance payers. Communication and Collaboration: Collaborate with internal stakeholders such as credentialing teams, provider relations, billing departments, and external parties including providers, insurance companies, and regulatory agencies to resolve enrollment-related issues, discrepancies, and inquiries. Policy Adherence: Stay updated on changes to healthcare regulations, payer enrollment guidelines, and industry best practices to ensure compliance and adherence to applicable standards in provider enrollment processes. Quality Improvement Initiatives: Identify opportunities for process improvement, efficiency enhancement, and quality enhancement in provider enrollment workflows. Propose and implement strategies to streamline processes, reduce errors, and optimize productivity. Training and Education: Provide training, guidance, and support to internal staff involved in provider enrollment activities to ensure understanding of policies, procedures, and compliance requirements. Reporting and Documentation: Maintain accurate records, documentation, and audit trails of provider enrollment activities. Generate reports, analyze data, and track key performance indicators to monitor compliance, identify trends, and support decision-making. Qualifications Bachelor's degree in any related field. Minimum of 2-3 years of experience in healthcare provider enrollment, credentialing, or related areas. Experience in quality assurance, auditing, or compliance roles is highly desirable.

Role: Credential Specialist Minimum 6 months expr into credentialing Only immediate joiners preferrable Night shift timings Location: Chennai Direct walk-in interview Thanks JS4U 7200217280

Sound knowledge in Healthcare concept. Should have 6 months to 3 Yrs of AR calling Experience. Excellent Knowledge on Denial management. Should handle US Healthcare providers/ Physicians/ Hospital's Accounts Receivable. Required Candidate profile Notice Period: Immediate joiners or candidates with a maximum 15-day notice period are highly preferred. Job Location Bangalore / Chennai Email: manijob7@gmail.com Call or Whatsapp 9989051577

Extensive experience in payment posting. Min of 4-5 years of experience in payment posting. Good communication skills both verbal and written. Willing to work in Night Shift work location -Bangalore 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

Designation: AR Caller / Senior AR Caller Experience: Minimum 2 years in Hospital billing preferred. 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 / Noida Email: manijob7@gmail.com Call or 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 HR Simran Choudhary simranchoudhary@caplineservices.com 9258890586

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

Role Summary: This job takes the lead in providing effective team handling and timely delivery of assigned task and required a strong knowledge in denial management, Trend analysis and should be an expert in reports management and process analytics and a proven job knowledge in Hospital Billing. JOB SUMMARY This job gives an opportunity to work in a challenging environment to deliver high quality Solutions to meet the demands for our Global Customer. An ideal candidate should have experience in Hospital Billing and Denial Management. The candidate should be able to lead & own the Development of any Technical deliverables assigned to him\her & thereby delivering high quality & Innovative solutions for the client. Should be an excellent Team player & have excellent Problem solving & communication skills ESSENTIAL RESPONSIBILITIES Monitors files to ensure completeness and accuracy. Review all file documentation for compliance with quality standards and relevant policies. Prepare and provide information to client based on their expectation. Identifies and recommends improvements to workflows and processes to improve accuracy and efficiency. Specialized knowledge on Microsoft Excel required to perform daily inputs, building functions, sorting, and filtering large amounts of data. Adhere to all company and department policies regarding security and confidentiality. Interpret data using analytics, research methodologies, and statistical techniques. EDUCATION Required Should be a Graduate in any Stream Flexible to work from Office all 5 days in the week EXPERIENCE Required 3 - 5 Years of Provider Credentialing Experience Preferred Through knowledge of working on Provider Credentialing Added advantage of working on CAQH, Cactus and Acorn Must be extremely detail oriented and able to multitask Possess a high level of Self-motivation and energy with minimal supervision Highly developed oral and written communication skills Ability to work both independently and in a team-oriented environment. Possess good organizational skills and strong attention to detail. Work in a standard protocols/documents to accurately complete the work assigned. Consistently document work assignment, enrollment follow up status, and relevant in-process tasks within the specified systems and time frames Should develop knowledge about payor policies Develop the team's talent, drive employee retention and engagement.

Experience: 1-2 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: Mysore, Bangalore Chennai Email: manijob7@gmail.com Call or Whatsapp 9989051577

Team Lead - RCM with proven experience as TL/SME in end-to-end RCM Job location: Erode Only Male candidates Salary Offered: 6 LPA - 7 LPA As an RCM Team Lead, you will be responsible for Team handling, work allocation, client interactions, and distributing RCM metrics reports to the leadership team. Excellent communication skills, attention to detail, and strong technical and problem-solving skills are essential aspects of this role Experience in handling a team/group of 20 to 30 FTEs Thorough understanding of RCM processes like Billing, Cash Posting, Credit balance, IV verification, Authorization, Account Receivables, Denial Management & Correspondence review. Very good understanding of RCM metrics like Days in AR, aging above 90 days, collections, and bad debt Periodically review team performance and recommend PIP whenever required Conduct regular team meetings, training sessions, and performance reviews Hands-on in preparing daily, weekly, and monthly operational metrics reports from the software using Excel Identify trends and patterns from the generated reports and initiate an action plan to resolve the AR issues Review and analyze aging reports, denial trends, and outstanding claims Identifying issues, resolving and escalating them to Managers Responsible for work allocation and distribution to the team, and monitoring the team's work Create and maintain daily operational scorecards to track and report KPIs, assist in volume forecast and capacity planning as required Handle client communications and resolve escalations efficiently Should be an expert in using MS Excel

Summary As an AR Manager you should have end to end knowledge of RCM and Medical Billing. Must be capable of handling the team and analyzing the status of claims for the outstanding balances on patient accounts and taking appropriate actions. Manage A/R accounts by ensuring accurate and timely follow-up. Ensure that the deliverable to the client adhere to the quality standards What youll do Train associates on AR and identify improvement areas Allocate accounts to team members Review denial and AR reporting (Waystar) Analysis / insights about root cause of denials Monitor denial trends by reason, payer, CPT, etc. Establish relationships with payer stakeholders (director level) to discuss issues / non payment Lead weekly CI meetings to: Credentialing Clinics not responding Timely filing denials Present AR and denials status along with insights Escalate issues related to payers (I.e., we need help with this payer because X, here are examples) Escalate issues related to clinic ops Maintain project-related documents (SOPs, training materials, workflows) What you have Any Degree Experience working AR Experience leading teams and leading team leads (leading leaders) Understanding of California / IPA payer landscape Experience with contracts Experience calling payers / establishing relationships with payer stakeholders Communication / presentations skills Analytic mindset Experience documenting materials / SOP At least 10 years experience in RCM Knowledge of Healthcare terminology and ICD/CPT codes will be considered a plus KPIs for performance AR Days Repeated Denials Denial follow-up turnaround time Indirect: denial rates should be decreasing