Credentialing Specialist

As a Credentialing Specialist at SGH Management India Pvt Ltd., you will be an essential part of the Revenue Cycle Management (RCM) team. Your primary responsibility will be to ensure that healthcare providers are appropriately credentialed with insurance companies, facilitating the smooth submission and reimbursement of claims. You will collaborate closely with our billing team, healthcare providers, insurance companies, and regulatory bodies to guarantee accurate and timely credentialing processes. Your duties will include coordinating with healthcare providers to collect necessary documentation such as licenses, certifications, insurance details, and other relevant materials. You will be responsible for submitting and monitoring credentialing applications with various insurance companies and health networks, ensuring efficient processing. Additionally, verifying the accuracy of provider data within RCM systems to maintain current records on each healthcare professional's credentials will be a key task. In case of any credentialing-related issues or discrepancies, you will liaise with insurance carriers and providers to address and resolve concerns promptly. Monitoring and managing the expiration of credentials and licenses to ensure timely re-credentialing will also be part of your role. You will assist in internal audits and compliance reviews to uphold industry standards in credentialing practices and support the maintenance and update of credentialing policies and procedures. Qualifications for this role include a high school diploma or equivalent, with a preference for a bachelor's degree in healthcare administration, business, or a related field. You should have a minimum of [X] years of experience in credentialing or provider enrollment, preferably in the RCM or healthcare sector. Familiarity with RCM processes, including billing, coding, and insurance claims submission, is essential, along with proficiency in credentialing software and systems such as CAQH and Verity. Strong organizational and time management skills, keen attention to detail, excellent written and verbal communication abilities, and the capacity to handle multiple tasks and meet deadlines in a fast-paced environment are crucial for success in this role. Additionally, problem-solving skills and the ability to efficiently resolve credentialing issues are highly valued. Preferred skills include experience with Revenue Cycle Management (RCM) software systems. This is a full-time position with benefits including provided food and Provident Fund. The work schedule is in the US shift, and the ideal candidate will have at least 1 year of total work experience. To apply for this position, please share your CV with ssangar@scale-healthcare.in or contact us at 8699557349.,