5 Pecos Jobs

Summary Green Apples is looking for driven, dedicated and experienced Credentialing & Enrolment professionals, proficient in US healthcare, who are comfortable working in evening shift starting at 4pm IST. Noida based Company, currently working from home. Local candidates from Delhi-NCR only need to apply. Description Hiring multiple candidates with 1 year and more, hands-on working experience in Credentialling Candidates with minimum of 1 year experience in Credentialling & enrolment alone only need to apply. Should have knowledge base of end-to-end provider US healthcare credentialing. Should be able to work independently with minimum or no supervision. Should have experience in credentialing with Medicare, Medicaid, their HMOs and Commercial payers. Good experience n CAQH, PECOS application. Tracks expiration dates and maintains current state licenses, DEA certification, malpractice coverage and any other required documents for all providers. Malpractice coverage and any other required documents for all providers. Compiles information and sets up provider files Set up all ERA and EFT enrolments Completes initial provider credentialing applications, monitors applications and follows up as needed. Track all expired provider certification. Initiate re-credentialing application as requested by insurance companies. Collect all the data and documents required for filling credentialing application from the physicians/ clinics Store the documents centrally on our secure document management systems. Strong communication skills in English with a neutral accent. Detail-oriented with excellent follow-up abilities Proficiency in Microsoft office tools Ability to juggle multiple priorities successfully. Willingness to work in the evening shift Qualifications: Graduate/ Masters degree in the related field Capability to converse clearly and precisely with US clients and payers, credentialing department personnel, by phone and email Excellent computer skills Excellent command over English with excellent written and verbal communication skills Excellent management skills Excellent Analytical Skills. Perks and Benefits Perks and Benefits: As per industry standard

Oversee complete credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and ongoing monitoring Compliance with accreditation bodies, government regulations, payer requirements, and organizational policies Required Candidate profile Exp in CAQH, PECOS Exp in Medicare, Medicaid, and Commercial insurance enrolment Maintain accurate records and databases of healthcare providers Good in filling insurance enrollment applications

Role: Credentialing Specialist, US Healthcare Location: Pune/Mumbai/Nagpur (Work from Office) (Address details mentioned below) Company Profile: First Insight is a software product development and revenue cycle management company based in Portland, Oregon (USA). It has its India development and service delivery centres in Pune, Mumbai and Nagpur. Its expertise and domain lies in healthcare and insurance. Its a forward thinking, visionary company that provides high quality software solutions, services, support and training to nearly a thousand optometric and ophthalmic practices in the United States. It has carved a niche in the healthcare industry with its practice management and electronic health records software, support, e- commerce solutions and revenue cycle management services. To know more about First Insight, please visit @ www.first-insight.com Following would be the Duties/Responsibilities for Credentialing Specialist: 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 Interested Candidate can also share their resumes directly to the recruiters below: Rohit Ghate - 7888025217 rohitghate@first-insight.com Address details: Registered Office Address- Pune: First Insight Software Solutions (I) Pvt. Ltd., 2nd Floor, Server Space, AG Technology Park, Off ITI Road, S. No.127/1A, Plot No.8, Aundh, Pune 411 007 Mumbai: Unit No. 302, 3rd Floor, New Technocity, Plot No. X-4/5A, TTC Industrial Area, Mahape MIDC, Navi Mumbai - 400 710 Nagpur: Unit No. 201, 2nd Floor, Wing - C, VIPL IT Park, Plot No. 28, MIDC IT Park, Gayatri Nagar Road, Parsodi, Nagpur - 440 022

Job Summary: The Credentialing and Contracting Specialist is responsible for ensuring that healthcare providers meet all necessary licensing, certification, and compliance requirements to participate in various insurance networks. This role involves verifying credentials, maintaining provider databases, negotiating contracts, and ensuring regulatory compliance with payer and accreditation standards. Roles and Responsibilities Credentialing Duties: Collect, review, and verify healthcare provider credentials, including licenses, certifications, education, and work history. Maintain accurate and up-to-date credentialing files in compliance with regulatory bodies (e.g., CMS, NCQA, JCAHO). Submit and process provider applications for enrollment in insurance networks and monitor approval status. Track and ensure timely re-credentialing of providers to prevent lapses in participation. Communicate with providers regarding missing or expired documentation and resolve credentialing issues. Contracting Duties: Assist in negotiating provider contracts with insurance companies, hospitals, and other healthcare organizations. Prepare, review, and update contracts, fee schedules, and reimbursement terms. Maintain an organized database of contracts and ensure compliance with contract terms. Serve as a liaison between providers and payers to facilitate contract execution and resolution of disputes. Monitor contract renewals and modifications, ensuring providers remain in good standing with payers. Qualifications Any bachelors degree preferred. Minimum of 2+ years of experience in credentialing, contracting, or provider enrollment. Strong knowledge of healthcare regulations, payer requirements, and credentialing standards. Experience with credentialing software and provider enrollment systems. Excellent attention to detail and organizational skills. Strong communication and negotiation skills. Ability to manage multiple tasks and meet deadlines in a fast-paced environment. Willing to work on night shifts (US Timings) Preferred Qualifications: Experience working with commercial and government payers (Medicare, Medicaid). Knowledge of CAQH, PECOS, and other credentialing databases. Certification in healthcare credentialing (e.g., CPCS, CPMSM) is a plus

Minimum 1-3 years of experience working in credentialing. Candidate must have knowledge in END to END provider credentialing Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid. Required Candidate profile Candidate must have knowledge in creating & attesting the CAQH profiles Group Medicare and Medicaid Enrollment/Contracts. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.