Operation Associate

6 days ago

Chennai, Tamil Nadu, India Assured Full time ₹ 2,50,000 - ₹ 7,50,000 per year
Overview

We're seeking a Provider/Payer Enrollment to manage the critical process of enrolling and credentialing healthcare providers with various insurance payers, including commercial, Medicare, and Medicaid plans. This role is essential for ensuring providers are able to bill for services and for maintaining a healthy revenue cycle. The ideal candidate will be highly organized and have a strong understanding of US healthcare regulations and credentialing processes.

Responsibilities

  • Enrollment and Credentialing: Prepare and submit provider enrollment applications, re-enrollments, and re-credentialing documents to commercial, Medicare, and Medicaid payers.

  • Documentation Management: Maintain and update provider files with accurate information, including licenses, certifications, and other credentialing paperwork. This involves a high degree of attention to detail to prevent delays.

  • Communication and Follow-up: Act as the primary point of contact with payer representatives to track application statuses, address issues, and resolve any denials or requests for additional information in a timely manner.

  • Database Administration: Accurately enter and manage provider data within our credentialing and billing software, including systems like CAQH and PECOS.

  • Compliance Monitoring: Stay current with changes in payer enrollment regulations and requirements to ensure all applications are compliant with state and federal guidelines.

  • Internal Collaboration: Work closely with billing, coding, and provider relations teams to ensure a smooth and efficient process from provider onboarding to billing.

Qualifications

  • Experience: At least 1 plus years of experience in Provider/payer enrollment, credentialing, or medical billing within the US healthcare system.

  • Education: Bachelor's degree in healthcare administration or a related field is preferred.

  • Technical Skills: Proficiency with Microsoft Office Suite (Word, Excel) and experience with credentialing software or payer portals (e.g., CAQH, PECOS).

Skills

  • Exceptional attention to detail and organizational skills.

  • Strong written and verbal communication skills.

  • Ability to work independently, manage multiple deadlines, and problem-solve effectively.

  • Knowledge of medical terminology and the US healthcare revenue cycle.

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