Credentialing Specialist

Company Overview

Total RCM Solutions is a leading revenue cycle management company serving healthcare providers across the USA. With over 100+ years of combined expertise, the company offers comprehensive end-to-end RCM services and specialized solutions, including appeal management and patient services. Headquartered in Bangalore, Total RCM Solutions is committed to optimizing healthcare practices through efficient processes and best practices recommendations. Visit our website for more information.

Job Overview

We are seeking a dedicated Credentialing Specialist to join our team in Bengaluru on a full-time basis. The specialist will be responsible for managing and optimizing the credentialing and re-credentialing process for healthcare providers within our network. This role requires a detailed-oriented individual with a background in medical billing and a strong understanding of healthcare regulations and compliance standards.

Qualifications and Skills

• Proven experience in credentialing and re-credentialing processes within the healthcare industry.
• Thorough knowledge of healthcare regulations, compliance standards, and payor requirements.
• Excellent communication skills, both verbal and written, with the ability to interact with various stakeholders.
• Strong organizational skills and attention to detail for managing credentialing documents and timelines.
• Ability to handle sensitive information with confidentiality and professionalism.
• Proficient in using healthcare management systems and technology solutions for credentialing tasks.
• Adaptability and problem-solving skills to address complex credentialing issues promptly.
• Must have a customer-oriented approach to ensure seamless interactions with healthcare providers.

Roles and Responsibilities

• Manage and maintain the credentialing files for all healthcare providers within the network.
• Ensure timely re-credentialing by monitoring expirations and keeping track of necessary renewals.
• Coordinate with healthcare providers to obtain all required documentation for credentialing purposes.
• Review and verify professional eligibility, certifications, and licenses according to industry standards.
• Communicate with payors and other entities to facilitate successful enrollment and network participation.
• Keep informed about changes in credentialing regulations to ensure compliance and efficiency.
• Provide support to healthcare providers by resolving credentialing inquiries and issues effectively.
• Contribute to the ongoing development and improvement of credentialing processes and systems.