Job Summary
Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy.
Qualifications and Requirements
- Any Graduates and Post Graduates.
- 1-4 Years of experience in end-to-end process of Provider Enrollments/ Insurance Credentialing, Provider Contracting, and Re-Credentialing.
- Knowledge of Microsoft Office (Word, Excel, Outlook).
- Excellent written and verbal communications.
Essential Functions
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
- Maintain 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.
- Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid etc.
- Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, Payer directory and CMS databases.
- Maintain strict confidentiality in accordance with HIPAA regulations and company policy
- Meeting daily/weekly and monthly targets set for an individual.
Required Competencies
- Must have minimum 1 year of experience in end-to-end process of Provider Enrollments/ Insurance Credentialing, Provider Contracting, and Re-Credentialing
- Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle.
- Should be willing to work in US Shift. (6:00 PM to 3:00 AM).
- Excellent customer service skills; communicates clearly and effectively
- Ability to work independently as well as in a team environment.
- Ability to prioritize and manage work queue.
- Good typing skills with a speed of min 30-35 words /min.
- Strong interpersonal skills with a focus on customer service. Personable and positive demeanor, especially when dealing with customers and patients.
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