Credentialing Specialist
1 day ago
Role -
Credentialing Specialist / Analyst will be responsible for meeting the set SLAs, viz, productivity, quality and attendance.
Requirements -
- Education: Graduates / Diploma holders
- Knowledge: US Medical billing, provider credentialing
- Experience: 1 to 2 years for Analyst and 3 years – 5 years for specialist
- Knowledge of provider credentialing and contracting with government and commercial Insurance plans
- Minimum 1 year of experience in submitting applications for contracting and credentialing with Insurance plans
- Excellent computer skills including Excel, Word, and Internet use
- Plans and priorities to meet deadlines.
Key Responsibilities -
- Maintain individual provider files and group information to include up to date information needed to complete the required government and commercial payer credentialing applications.
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Collect and maintain files in relation to credentialing of network providers including current provider licenses, DEA certificates, malpractice insurance, board certifications, and other pertinent forms need for enrolment
- Maintain internal trackers to ensure all information is accurate and logins are available and legible
- Update each provider's CAQH database file timely according to the schedule published by CMS
- Complete revalidation requests issued by government payers
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