Sr. Credentialing Specialist- DME

Med Karma is a global revenue cycle management company based in Mohali district. We specialize in providing medical billing companies and healthcare providers with tailored solutions to improve financial viability. Our services include streamlining administrative processes, reviewing claims, ensuring policy compliance, and recommending error correction methods. Website: www.medkarmarcm.com

Role Description:

In this role, the Credentialing Specialist will be responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals, and patient care facilities and maintain up-to-date data for each provider in credentialing databases and online systems, ensuring timely renewal of licenses

and certifications. Understands CMS Medicare, Medicaid, and managed care billing, credentialing and enrollment requirements and reimbursements methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges. Assist in the development of resources for researching issues. 

Roles and Responsibilities:

·  Screening practitioners’ applications and supporting documentation to ascertain their eligibility.

·  Identifying discrepancies in information and conducting follow-ups.

·  Medicare & Medicaid enrollment and revalidation.

· Processing initial credentialing and re-credentialing applications with follow up to ensure that credentialing is completed, and providers enrolled in health plan products.

·  CAQH profile creation.

·   Maintenance of internal and external databases (CAQH, PECOS, NPPES).

·   Initial and reappointment of hospital privileges.

·   Assisting internal customers with credentialing inquiries.

·  Actively participates in group leadership meetings and is accountable for credentialing status for all groups.

· Coordinates and facilitates troubleshooting with payer networks to resolve any issues related to enrollments.

·  Experience in contract negotiations is beneficial. 

SKILLS REQUIRED:

DME Credentialing

·      Should have basic knowledge of the entire Revenue Cycle Management (RCM). 

·      Excellent analytical and problem-solving skills. 

·      Experience with Denials and Insurance processing. 

·      Excellent English written and oral communication skills. 

Why work with us?

• Multicultural environment to explore, learn and grow.

• Best remuneration, Incentives and bonuses, free Cab and Food facilities.

• Wide range of training and certifications available for career development.

How to Apply