Senior Credentialing Specialist SGH Management India Pvt Ltd

3.0 - 7.0 years

0 Lacs

punjab

On-site

As a Credentialing Specialist at our company, your primary responsibility will be to manage all provider credentialing activities efficiently. This includes collecting, verifying, and maintaining essential provider information such as licenses, certifications, and work history. You will also be responsible for submitting credentialing applications to insurance companies and credentialing bodies. In addition to provider credentialing, you will be tasked with tracking and completing re-credentialing and re-enrollment processes before expiration dates. Data management is a crucial aspect of this role, where you will update credentialing databases and ensure that all documents are current and accurate. Compliance with industry standards is paramount in this position. You will need to ensure that all credentialing activities adhere to regulations set forth by NCQA, CMS, and JCAHO. Furthermore, you will be responsible for preparing for and supporting internal and external audits to maintain compliance. Effective communication and coordination are essential skills for this role. You will act as a liaison between providers, insurance companies, and billing teams to facilitate smooth operations and resolve any issues that may arise. To excel in this role, you should have a solid understanding of revenue cycle management processes and healthcare insurance systems. Attention to detail and strong organizational skills are crucial for success. Proficiency in using EMR/EHR systems and credentialing software, such as Modio and Verity, is preferred. A good grasp of HIPAA regulations and credentialing compliance standards is also required. This is a full-time and permanent position that involves working night shifts in person at our designated work location. As part of our benefits package, we offer Provident Fund contributions. If you meet the requirements and are interested in this opportunity, please share your resume with us at ssangar@scale-healthcare.in.,

Posted 3 days ago

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Data Analyst (L2/L1) FIGmd

3.0 - 7.0 years

0 Lacs

pune, maharashtra

On-site

As a Subject Matter Expert in the healthcare domain based in Pune, you will be responsible for performing clinical data mining from various health systems and transforming it into a normalized form. Your key responsibilities will include understanding and performing data exploration and data mining of healthcare clinical and claims data. You should have a good understanding of EHR database mapping, data structure, clinical documentation structure, and HIPAA regulations. Working closely with internal teams, stakeholders, and customer contacts to implement operational processes for project delivery will be essential. Additionally, you will be expected to understand large-scale hospital datasets/warehouses, organize, collect, and standardize data, as well as study current applications and processes to build a knowledge repository and contribute to process enhancement. The ideal candidate should have 3-5 years of experience in the US Healthcare domain in EHR data migration/implementation or healthcare application integration. Hands-on experience in SQL query development, Linux, Python, and/or R is required, along with knowledge of cloud platforms. Possessing good interpersonal and communication skills is a must-have for this role. Experience in hospital EHR implementation and migration, as well as understanding of HIS & EHRs like Allscripts, Athena, and eCW, would be a nice-to-have. Familiarity with healthcare terminologies, standards, and applications like EMR/EHR, LIS, Code Systems (e.g., SNODMED, CPT & Diagnosis Code, NDC, LOINC) is advantageous. Knowledge of tools like JIRA, Confluence, and Service Desk is preferred. To qualify for this position, you should be a graduate or equivalent with experience in recognized global IT services/consulting companies in the healthcare domain. Please note that the job description is subject to change based on the company's requirements and your future competencies and qualifications.,

Posted 2 weeks ago

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