Credentialing Specialist

6 days ago


Karachi, Sindh, Pakistan beBee Careers Full time
Healthcare Credentialing Professional

About this Role:

This role involves managing the entire credentialing process, from initial applications to ongoing maintenance and re-credentialing for healthcare providers. Key responsibilities include verifying and maintaining accurate provider information, submitting enrollment applications to various insurance carriers and government agencies, and ensuring provider compliance with industry regulations and insurance requirements.

Responsibilities:
  • Manage the entire credentialing process, from initial applications to ongoing maintenance and re-credentialing for healthcare providers.
  • Verify and maintain accurate provider information, including licenses, certifications, and insurance policies.
  • Submit enrollment applications to various insurance carriers and government agencies.
  • 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.
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.
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.
Benefits:
  • Private healthcare insurance for you and your immediate family.
  • Company-paid lunch or dinner shifts.
  • A generous annual leave policy.
  • Paid professional development training and certifications if required.


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