
Credentialing Specialist
7 days ago
- Provider Credentialing: Prepare, submit, and maintain credentialing and re-credentialing applications for physicians and other healthcare providers.
- Data Management: Compile and maintain accurate provider data in credentialing databases and systems, such as CAQH, PECOS, and NPPES.
- Verification Processes: Conduct primary source verification of state licenses, DEA certificates, board certifications, and other relevant credentials.
- Enrollment Coordination: Manage the enrollment process with various insurance payers, ensuring timely submission and follow-up to achieve in-network status.
- EDI, ERA, and EFT Enrollment: Initiate and complete Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA), and Electronic Funds Transfer (EFT) enrollments to establish electronic claims submission, remittance processing, and payments from insurance carriers.
- Compliance Monitoring: Stay updated with current regulations, policies, and guidelines related to credentialing and enrollment to ensure organizational compliance.
- Documentation Maintenance: Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
Job Type: Full-time
Pay: Rs60, Rs100,000.00 per month
Work Location: In person
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