Credentialing Specialist, US Healthcare

Role:

Company

• Maintain individual provider files to include up to date information needed to complete the required federal and commercial payer credentialing applications.
• Maintain an internal provider grid to ensure all information is accurate and logins are available.
• Update each provider's CAQH database file timely according to the schedule published by CMS.
• Tracks expiration dates and maintains current state licenses, DEA certification, malpractice coverage and any other required documents for all providers.
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
• Track all expired provider certification. initiate re-credentialing application as requested by insurance companies.
• Follow up with providers for missing information or documents.
• Complete revalidation requests issued by federal payers.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers.
• Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Streamline the credentialing process by efficiently collecting all necessary documentation, including accreditation, membership, and facility privileges (e.g., License, NPI letter).
• Guide and support providers in completing payer forms, ensuring strict compliance with payer expectations.
• Address provider inquiries regarding the progress of the credentialing process promptly and professionally.
• Proactively notify clients of new regulations, impending certificate expirations, reapplications, and any deficiencies in credentialing requirements.

Qualifying Criteria:

• At least 1+ year of experience in Credentialing process in US Healthcare (End to End RCM Process)
• Ability to multi-task
• Good organization skills demonstrating the ability to execute timely follow-ups
• Willingness to be a team player and show initiative where needed

• Ready to work in night shifts

• Excellent oral and written communication skills

Salary: Remuneration will be at par with the best industry standards ; will not be a constraint for the right candidate.

Perks & Benefits :

• Attractive Incentives Plan
• Travelling Allowance
• Mediclaim
• Monthly Rewards

Rohit Ghate - 7888025217

rohitghate@first-insight.com

Address details: