Credentialing Professional

2 days ago


Lahore, Punjab, Pakistan beBee Careers Full time
Credentials Specialist Job Description

We are seeking an experienced Credentials Specialist to join our medical billing team. The successful candidate will be responsible for ensuring that all healthcare providers are properly credentialed and enrolled with payers, in accordance with regulatory requirements.

Key Responsibilities:
  1. Provider Credentialing: Verify provider credentials, including education, training, licensure, and certification.
  2. Payer Enrollment: Enroll providers with payers, including Medicare, Medicaid, and commercial insurance companies.
  3. Application Preparation: Prepare and submit credentialing and enrollment applications to payers.
  4. Follow-up and Resolution: Follow up with payers to resolve any issues or discrepancies related to credentialing and enrollment.
  5. Maintenance of Credentialing Records: Maintain accurate and up-to-date records of provider credentials and enrollment status.
  6. Compliance: Ensure compliance with regulatory requirements, including HIPAA and state-specific laws.
Requirements:
  1. Education: High school diploma or equivalent required; associate's or bachelor's degree preferred.
  2. Experience: 2+ years of experience in credentialing, medical billing, or a related field.
  3. Certifications: Certified Provider Credentialing Specialist (CPCS) or Certified Credentialing Specialist (CCS) certification preferred.
  4. Skills: Strong analytical, organizational, and communication skills. Ability to work in a fast-paced environment and meet deadlines.


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