Insurance Credentialing Specialist

Company Overview

Total RCM Solutions is a premier revenue cycle management firm assisting healthcare providers across the USA. Established in 2018, our team collectively boasts over 100 years of expertise, offering tailored services that optimize practice operations. From comprehensive revenue cycle management to individualized solutions, we ensure adherence to coding guidelines and provide multilingual patient support, serving both healthcare entities and other RCM firms.

Job Overview

This full-time, hybrid role based in Bengaluru offers a mid-level position as an Insurance Credentialing Specialist. The successful candidate will have 4 to 6 years of experience in the field of credentialing. You will be responsible for managing provider enrollments, handling credentialing processes, and maintaining high attention to detail. The role requires strong expertise in CAQH management and provider enrollment.

Qualifications and Skills

• Extensive experience in CAQH Management ensuring timely and accurate credentialing of healthcare providers (Mandatory skill).
• Proficiency in Provider Enrollment processes to facilitate smooth onboarding of new practitioners (Mandatory skill).
• Strong Attention to Detail to maintain and update provider information accurately (Mandatory skill).
• Experience in Medicare/Medicaid Credentialing, ensuring compliance with all relevant regulations.
• Knowledge in Insurance Verification, adept at confirming coverage and mitigating potential issues.
• Proven abilities in Payer Contracting, negotiating terms that benefit both providers and the company.
• Hands-on familiarity with Credentialing Software to streamline and automate processes efficiently.
• Demonstrated ability to collaborate effectively within a team to drive successful credentialing outcomes.
• Exceptional communication skills to engage with external partners and internal teams effectively.

Roles and Responsibilities

• Manage and oversee the entire credentialing process for healthcare providers, ensuring compliance with payor regulations.
• Coordinate provider enrollment applications and maintain swift processing times for new enrollments.
• Collaborate with insurance companies and medical facilities to uphold high standards in credentialing.
• Ensure all provider data in CAQH and various systems is up-to-date and accurate.
• Address and resolve discrepancies or issues during the credentialing process in a timely manner.
• Liaise with insurance payers for efficient contract negotiations and relationship management.
• Work closely with cross-functional teams to ensure seamless workflow integration.
• Stay informed on current industry practices and updates to maintain compliance and best practices.