Credentialing Specialist

1 week ago

Karachi, Sindh, Pakistan HKDL Full time

As a Credentialing Specialist at HKDL, you will be responsible for all aspects of credentialing and re-credentialing of health care professionals. This position ensures all health care professionals are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database. This position primarily works independently, but frequently coordinates with other team members.

Responsibilities:
  • Effectively perform the credentialing process for all types of medical and behavioral providers credentialing and contracting.
  • Frequent follow-ups.
  • Attestation of CAQH.
  • Maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
  • Communicate effectively both orally and in writing.
  • Respond to emails timely and effectively.
  • Create all insurance portals.
  • Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
Requirements:
  • Proven experience as a Medical Biller in a US healthcare setting or similar role.
  • Proficiency in medical billing software and electronic health records (EHR/EMR) systems.
  • In-depth knowledge of medical terminology, coding (CPT, ICD-10, HCPCS), and insurance billing procedures.
  • Strong understanding of healthcare compliance and privacy regulations (HIPAA).
  • Excellent communication skills with the ability to interact professionally with patients, insurance companies, and healthcare providers.
  • Detail-oriented, analytical mindset and ability to work efficiently in a fast-paced environment.
  • Must have 2 to 3 years of experience.
  • Knowledge of Medicare, Medicaid, IPAs & Medicare Advantage plans.
  • Proficiency in Microsoft Office Suite and other relevant software.
Qualifications:
  • Excellent organizational and time management skills.
  • Ability to multitask and prioritize tasks effectively.
  • Experience in credentialing.
  • Strong verbal and written communication skills.
  • Bachelor's degree in business administration or related field.
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