Healthcare Provider Credentialing Specialist

20 hours ago

Karachi, Sindh, Pakistan beBeeCredentialing Full time

About Credentialing and Provider Management

Job Summary
  • Manage provider applications, enrollments, and ongoing maintenance.
Key Responsibilities
  1. Coordinate credentialing process from initial application to re-credentialing for healthcare providers.
  2. Submit enrollment applications to insurance carriers and government agencies.
  3. Maintain accurate provider information, including licenses, certifications, and insurance policies.
  4. Organize records of credentialing documents, expirations, and updates.
  5. Stay up-to-date on industry regulations and insurance requirements.
  6. Liaise with insurance companies, healthcare providers, and relevant parties to resolve credentialing issues.
  7. Identify and address obstacles in the credentialing process.
  8. Collaborate with RCM staff to resolve provider credentialing issues.
  9. Maintain provider profiles on databases like CAQH, PECOS, NPPES, and CMS.
  10. Update internal provider grid for data accuracy and accessibility.
  11. Generate reports to support credentialing decisions.
Requirements
  1. Minimum 3 years of experience in healthcare credentialing or related fields.
  2. Strong knowledge of medical billing, coding practices, healthcare regulations, and insurance policies.
  3. Bachelor's Degree in Computer Science, Healthcare Administration, or Commerce-related field preferred.
  4. Proficiency in English, GSuite, Slack, and excellent problem-solving skills.
  5. Solid understanding of billing software and electronic medical records.
  6. Exceptional communication and time management skills.
KPIs
  1. Application Processing Time: Submit applications within 24-48 hours.
  2. Application Accuracy: Aim for 95–100% accuracy.
  3. Application Approval Rate: Achieve a 95% approval rate on first submission.
  4. Timely Follow-Up: Promptly follow up on additional documentation requests.
Benefits
  1. Private healthcare insurance (OPD + IPD).
  2. Company-paid lunch or dinner shifts.
  3. 14 days of annual leave and 10 days of casual or sick leave.
  4. Paid professional development training and certifications if required.

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