Opening For Provider Credentialing
3 days ago
We have an immediate job opening for Credentialing - Subject Matter Expert in medical billing US Healthcare Industry.
Experience: 3 - 5 Years
Salary: Best in the industry
Job Location: Perungudi, Chennai
Job Description:
Responsible for leading the credentialing team members in daily tasks,
work distribution to Credentialing Specialists of credentialing/re-
credentialing applications for providers and facilities.
Excellent people management skills.
Should have extensive knowledge in CAQH, PECOS
Should have extensive knowledge in perusing the payer contracts & find
any hidden languages in the contract that can cause a significant
hemorrhage of revenue for the practice before sending it to the practice
administrators & doctors for signing the contract.
Should maintain knowledge in making sure the countersigned & executed
contract is loaded in the payers system for the claims to reimburse as per
the contract.
Should possess the knowledge to track down the current status of the
credentialing/re-credentialing applications & be able to escalate it to the
next level for expediting the processing of the applications by reaching out
to the Network Reps/Supervisors/Network Directors/ Network VP
Maintain the Teams workload status reports and communicate provider credentialing
status internally.
Collects performance data and generates reports for both individual and team performance.
Maintain the Teams productivity & quality report & give feedback to the
team members on a daily basis & making sure the client essentials are
met.
Competencies include a high level of discretion to work with confidential information, solid
knowledge of credentialing processes, requirements, and NCQA guidelines.
Able to follow routine procedures consistently and efficiently, able to work
independently, and in conjunction with team members at all levels of the organization.
Excellent verbal and written communication skills, detail-oriented, able to resolve
problems quickly and effectively, able to motivate team and to delegate effectively.
Should be able to handle client escalations pertaining to credentialing &
contracting issues & fix them on a timely manner
Should maintain a competency chart with all credentialing activities and
monitor the performance of the team members on each task & train them
on the areas where they need training & improvement
Should be able to set quarterly & yearly goals for the team members & help
them achieve the same.
Should be able to do rate assessments on the payer contracts & negotiate
better rates with the network reps & network directors & help clients
increase revenue
Should involve in weekly & bi-weekly client calls and provide clients with all
credentialing updates
Should collaborate with the billing team to straighten out any credentialing
related denials
Knowledge of EDI/ERA/EFT enrollments, Payer portal & payment gateway
portal setup is an added advantage.
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