Openings For Senior Credentialing specialist Voice

3 weeks ago

Chennai, India LRS Billing Solutions Full time

Job description

Greetings from Lincoln reimbursement Service Private Limited

Role : Senior Credentialing specialist

Location : Chennai (WFH)

Experience : 4 Years to 7 Years

Benefits:

  • Salary Credit on 25th Every month
  • PF & 20 Lakh ICICI Health And Personal Insurance
  • Permanent work from home

Reports To: Credentialing Manager

Job Summary:

The Credentialing Specialist is responsible for managing the end-to-end credentialing and recredentialing process for healthcare providers with various insurance payers, including HMOs, IPAs, Medicare, Medicaid, and commercial insurers. This role ensures compliance with federal, state, and payer-specific regulations while maintaining accurate provider records to facilitate seamless billing and reimbursement.

Key Responsibilities:

1. Provider Credentialing & Enrollment

  • Process and submit credentialing applications to Medicare (PECOS), Medicaid, HMOs, IPAs, and commercial payers.
  • Ensure timely enrollment in CAQH, NPPES, and payer-specific portals.
  • Track application statuses and follow up with payers to resolve delays.

2. Provider File & Database Management

  • Maintain individual provider files with up-to-date documentation (licenses, DEA, board certifications, malpractice insurance, etc.).
  • Keep an organized tracking log for all contracted Managed Care Organizations (MCOs), Medicare, Medicaid, and CAQH updates.
  • Ensure all provider portal logins (PECOS, NPPES, CAQH, payer systems) remain active and accessible.

3. Compliance & Revalidation

  • Monitor and renew state licenses, DEA registrations, board certifications, and malpractice insurance before expiration.
  • Ensure CAQH profiles are attested and updated per CMS and payer schedules.
  • Stay updated on Medicare/Medicaid and MCO credentialing regulations.

4. Provider & Payer Communication

  • Work directly with providers to collect and verify required credentialing documents.
  • Serve as a liaison between providers, billing teams, and insurance payers to resolve credentialing issues.
  • Notify management of any credentialing delays that may impact billing.

Qualifications & Skills:

  • 4+ years of credentialing experience in US medical billing, preferably with HMOs, IPAs, Medicare, and Medicaid.
  • Strong knowledge of CAQH, PECOS, NPPES, and payer enrollment portals.
  • Familiarity with provider enrollment forms (CMS-855I, CMS-855O, etc.).
  • Detail-oriented with strong organizational and tracking skills.
  • Ability to manage multiple deadlines and prioritize workload.

Interested candidates, please share your profiles to Email ID with the following Application Question(s):

  • How many years of experience do you have in Credentialing?
  • Do you have WFH setup?
  • What is your last take-home salary?
  • What is your expected take-home salary?
  • May I know your notice period?

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