Credentialing Specialist

Job description

Position: Credentialing Specialist and Coordinator

Experience: 3+ year of US healthcare experience in Lab credentialing (Must have)

Shift: US Shift (6:30pm 3:30am IST)

ROLES AND REPONSIBILITIES:

• Collect all the data and documents required for filing credentialing applications from the providers. Complete providers credentialing and re-credentialing applications; monitor applications and follow-up as needed
• Maintain knowledge of current health plan requirements for credentialing process. Stay up to date on licensing, verification, and state specific rules and bylaws to maintain compliance
• Maintain current and accurate data for all providers. Ensure practice addresses/Phone number/ Fax Number are current with health plans
• Track license and certification expirations for all providers to ensure timely renewals
• Work with commercial and governmental payers for credentialing and enrolment of multiple provider specialties and facility types (Medicare, Medicaid and commercial insurances)
• Display in depth knowledge of and execution of all standard operating procedures (SOPs) as well as communicating issues, trends, concerns, and suggestions to management Identifying discrepancies in information and conducting follow-ups
• Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
• Ensure that facility/providers comply with federal and state regulations regarding licensure Maintain credentialing database and ensure up-to-date tracking of application process

JOB REQUIREMENT

• Should have worked in Credentialing for at least 3-years in medical billing service providers for Lab Billing
• Excellent Written & Verbal English Communication is essential
• Willing to work in US Shift
• Good Knowledge in Provider credentialing
• Experience in Insurance calling
• Good knowledge in filling insurance enrolment applications
• Experience in Medicare, Medicaid, and Commercial insurance enrolment
• Ability to plan, prioritize, and complete work to meet established objectives
• Highly proficient with computers, especially Word and Excel
• Ability to prioritize and manage work queue

Interested candidates can send their updated profile with current and expected salary