Provider Enrollment QA Specialist

Ventra Health

1 - 5 years

2 - 5 Lacs

chennai

Posted:None| Platform:

Apply

Skills Required

providing us healthcare auditing claims adjudication healthcare enrollment claims processing charge posting payment posting ar calling charge entry quality assurance denial management credentialing medical billing rcm revenue cycle management communication skills

Work Mode

Work from Office

Job Type

Full Time

Job Description

Overview

As a US Healthcare Provider Enrollment Quality Assurance Specialist, you will be responsible for ensuring the accuracy, completeness, and compliance of provider enrollment processes within a healthcare organization. You will play a critical role in maintaining high standards of quality and efficiency in provider enrollment activities to support the organization's revenue cycle management.

Responsibilities

Quality Assurance Oversight:
Conduct thorough reviews and audits of provider enrollment applications, documents, and data to ensure accuracy, completeness, and compliance with regulatory requirements, payer policies, and organizational standards.
Documentation Verification:
Validate and authenticate provider credentials, licenses, certifications, and other required documents submitted during the enrollment process to ensure authenticity and compliance with regulatory and payer requirements.
Application Processing:
Facilitate the timely and accurate processing of provider enrollment applications, including data entry, verification, and submission to relevant regulatory bodies and insurance payers.
Communication and Collaboration:
Collaborate with internal stakeholders such as credentialing teams, provider relations, billing departments, and external parties including providers, insurance companies, and regulatory agencies to resolve enrollment-related issues, discrepancies, and inquiries.
Policy Adherence:
Stay updated on changes to healthcare regulations, payer enrollment guidelines, and industry best practices to ensure compliance and adherence to applicable standards in provider enrollment processes.
Quality Improvement Initiatives:
Identify opportunities for process improvement, efficiency enhancement, and quality enhancement in provider enrollment workflows. Propose and implement strategies to streamline processes, reduce errors, and optimize productivity.
Training and Education:
Provide training, guidance, and support to internal staff involved in provider enrollment activities to ensure understanding of policies, procedures, and compliance requirements.
Reporting and Documentation:
Maintain accurate records, documentation, and audit trails of provider enrollment activities. Generate reports, analyze data, and track key performance indicators to monitor compliance, identify trends, and support decision-making.

Qualifications

Bachelor's degree in any related field.
Minimum of 2-3 years of experience in healthcare provider enrollment, credentialing, or related areas. Experience in quality assurance, auditing, or compliance roles is highly desirable.

More Jobs at Ventra Health

Charge Entry Specialist

Guindy, Tamil Nadu, India

Experience: Not specified

Salary: Not disclosed

Supervisor, Denial Specialist

Coimbatore, Tamil Nadu, India

5 - 8 yrs

Salary: Not disclosed

Human Resource Intern

Chennai

Experience: Not specified

Salary: Not disclosed

Director, Coding

Guindy, Tamil Nadu, India

Experience: Not specified

Salary: Not disclosed

Manager, Coding

Guindy, Tamil Nadu, India

8.0 - 8.0 yrs

Salary: Not disclosed

Mock Interview

Practice Video Interview with JobPe AI

Start Job-Specific Interview

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.