Conflicts Specialist, Risk Management

7 days ago

Mumbai, Maharashtra, India PracticeSuite, Inc. Full time
PracticeSuite, Inc. is an innovative platform to enable medical practices and other healthcare facilities to create an amazing patient experience. We are looking for an individual seeking a career opportunity with one of the fast-growing cloud computing software company in the country.

We are looking for a Credentialing Specialist, this position will perform administrative and technical tasks pertaining to credentialing new providers and maintaining credentials for current providers.

Manage the end-to-end credentialing and re-credentialing process for providers with Medicare, Medicaid, and major commercial insurance payers.

• Submit and track provider enrollment applications, group contracts, and facility participation agreements with federal and private payers.

• Communicate effectively with providers, practice managers, billing teams, and payers to resolve enrollment issues and delays.

• Keep internal systems updated with current credentialing status and documentation for audits and claims submission readiness.

• Identify and coordinate any risk management, substance abuse and/or malpractice issues. Maintains strict confidentiality of all records, data and occurrences as condition of initial and/or continued employment.

2–4 years of payer credentialing experience in an RCM, MSO, or medical group setting.

• Comprehensive understanding of federal payer systems (Medicare/PECOS, Medicaid) and major commercial payers.

• Experience managing multi-state enrollments and working with provider rosters.

• Exceptional communication and telephone skills required, as well as a great deal of patience and understanding.

• Experience working with physicians and/or senior executives preferred.

• Demonstrate the ability to prioritize heavy workload and work independently with minimal supervision.

• Proficient computer and internet skills; familiarity with Microsoft Office software required.

• Knowledge of medical terminology preferred.

• Shift - US Shift (6:30PM - 3:30AM)

PracticeSuite is a national, fast-growing cloud computing software company based in Tampa, FL that provides a cloud-based 360°Office Platform to healthcare facilities. PracticeSuite has an agile management team, high employee morale, and high customer satisfaction and retention. PracticeSuite is growing rapidly and is being recognized as one of the 5 top cloud-based systems within healthcare.

Please visit our website to learn more about us, at

LinkedIn Page:

PracticeSuite, Inc is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability, or veteran status. PracticeSuite, Inc also complies with all applicable national, state and local laws governing nondiscrimination in employment.

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