Opening For Provider Credentialing - SME

We have an immediate job opening for Credentialing - Subject Matter Expert in medical billing US Healthcare Industry.

Experience: 3 - 5 Years

Salary: Best in the industry

Job Location: Perungudi, Chennai

Responsible for leading the credentialing team members in daily tasks,

work distribution to Credentialing Specialists of credentialing/re-

credentialing applications for providers and facilities.

Excellent people management skills.

Should have extensive knowledge in CAQH, PECOS

Should have extensive knowledge in perusing the payer contracts & find

any hidden languages in the contract that can cause a significant

hemorrhage of revenue for the practice before sending it to the practice

administrators & doctors for signing the contract.

Should maintain knowledge in making sure the countersigned & executed

contract is loaded in the payers system for the claims to reimburse as per

the contract.

Should possess the knowledge to track down the current status of the

credentialing/re-credentialing applications & be able to escalate it to the

next level for expediting the processing of the applications by reaching out

to the Network Reps/Supervisors/Network Directors/ Network VP

Maintain the Teams workload status reports and communicate provider credentialing

status internally.

Collects performance data and generates reports for both individual and team performance.

Maintain the Teams productivity & quality report & give feedback to the

team members on a daily basis & making sure the client essentials are

met.

Competencies include a high level of discretion to work with confidential information, solid

knowledge of credentialing processes, requirements, and NCQA guidelines.

Able to follow routine procedures consistently and efficiently, able to work

independently, and in conjunction with team members at all levels of the organization.

Excellent verbal and written communication skills, detail-oriented, able to resolve

problems quickly and effectively, able to motivate team and to delegate effectively.

Should be able to handle client escalations pertaining to credentialing &

contracting issues & fix them on a timely manner

Should maintain a competency chart with all credentialing activities and

monitor the performance of the team members on each task & train them

on the areas where they need training & improvement

Should be able to set quarterly & yearly goals for the team members & help

them achieve the same.

Should be able to do rate assessments on the payer contracts & negotiate

better rates with the network reps & network directors & help clients

increase revenue

Should involve in weekly & bi-weekly client calls and provide clients with all

credentialing updates

Should collaborate with the billing team to straighten out any credentialing

related denials

Knowledge of EDI/ERA/EFT enrollments, Payer portal & payment gateway

portal setup is an added advantage.