Credentialing Specialist

4 weeks ago

Karachi, Sindh, Pakistan Circadia Technologies Ltd Full time

About Circadia:

Circadia is a dynamic and rapidly growing health tech startup on a mission to revolutionize healthcare through innovative mobile technology solutions. Our mobile apps empower healthcare professionals and patients alike to make informed decisions, streamline processes, and improve patient outcomes. We are a passionate team dedicated to making a positive impact in the healthcare industry.

Job Responsibilities
  • Manage the entire credentialing process, from initial applications to ongoing maintenance and re-credentialing for healthcare providers.
  • Manage and submit enrollment applications to various insurance carriers and government agencies.
  • Verify and maintain accurate provider information, including licenses, certifications, and insurance policies.
  • Maintain organized records of credentialing documents, expirations, and updates.
  • Stay up-to-date with industry regulations and insurance requirements to ensure provider compliance.
  • Liaise with insurance companies, healthcare providers, and relevant parties to resolve credentialing issues and inquiries.
  • Identify and address obstacles or challenges in the credentialing process promptly and effectively.
  • Collaborate with the RCM staff to resolve issues related to provider credentialing.
  • Maintain accurate provider profiles on databases like CAQH, PECOS, NPPES, and CMS.
  • Update and manage an internal provider grid to ensure data accuracy and accessibility.
  • Generate reports and insights to support credentialing and provider enrollment decisions.
  • Ensure all applications are documented in the Credentialing G_Drive. Follow-up and inquiries should be conducted via company-provided phone lines to track progress.
  • Suggest and implement process improvements to enhance credentialing efficiency and accuracy.
Job Requirements
  • Minimum of 3 years of relevant experience in healthcare credentialing or related fields.
  • Strong knowledge of medical billing, coding practices, healthcare regulations, and insurance policies.
  • Experience in RPM billing is preferred.
  • Bachelor's Degree in Computer Science, Healthcare Administration, or Commerce-related fields is preferred.
  • Proficiency in English, GSuite, Slack, and excellent problem-solving and organizational skills.
  • Solid understanding of billing software and electronic medical records.
  • Exceptional communication and time management skills.
  • Attention to detail is essential.
  • Ability to work independently and manage multiple projects simultaneously.
  • Knowledge of HIPAA requirements related to medical records and billing.
KPIs
  • Application Processing Time: Submit applications within 24-48 hours of request.
  • Application Accuracy: Aim for 95–100% accuracy, with minimal corrections needed.
  • Application Approval Rate: Achieve a 95% approval rate on first submission.
  • Timely Follow-Up: Promptly follow up on additional documentation requests.
  • Weekly Reports: Provide a weekly summary of application statuses and follow-ups.
Benefits
  • Private healthcare insurance (OPD + IPD) with Jubilee Platinum for you and your immediate family.
  • Company-paid lunch or dinner shifts.
  • 14 days of annual leave and 10 days of casual or sick leave.
  • Paid professional development training and certifications if required.
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