Credentialing Specialist

7 days ago

Lahore, Punjab, Pakistan Prima Systems Full time 80,000 - 100,000 per year

Job description:

We are seeking a detail-oriented and experienced Credentialing and Enrollment Associate to join our medical billing team. The ideal candidate will have a strong background in healthcare credentialing and enrollment processes, particularly within the US healthcare system. This role will involve ensuring that healthcare providers are properly credentialed with insurance networks and government programs, facilitating enrollment, and maintaining accurate records.

Responsibilities:

  • Manage the credentialing and enrollment process for healthcare providers with insurance networks, Medicare, Medicaid, and other relevant programs.
  • Prepare and submit credentialing applications, re-credentialing, and revalidation documents accurately and timely.
  • Ensure compliance with all credentialing requirements, regulations, and standards set by accrediting bodies and government agencies.
  • Communicate with insurance companies, providers, and internal stakeholders to resolve credentialing issues and inquiries.
  • Maintain up-to-date knowledge of current healthcare regulations, policies, and procedures related to credentialing and enrollment.
  • Coordinate with internal departments to gather necessary documents and information for credentialing applications.
  • Monitor the status of applications, track expirations, and follow up on pending items to ensure timely completion.
  • Maintain accurate and organized credentialing and enrollment records, both electronic and paper-based.
  • Assist in audits and reviews related to credentialing and enrollment processes.

Requirements:

  • Minimum of 2-3 years of experience in healthcare credentialing and enrollment, preferably in a medical billing setting.
  • In-depth knowledge of credentialing processes for insurance networks, Medicare, Medicaid, and other payers.
  • Familiarity with CAQH, NPI, UPIN, and other relevant healthcare databases and identifiers.
  • Strong understanding of healthcare regulations, compliance standards, and HIPAA guidelines.
  • Excellent English communication skills, both verbal and written, with the ability to interact professionally with providers and insurance representatives.
  • Exceptional attention to detail, accuracy, and organizational skills.
  • Proficiency in using MS Office applications and credentialing software.
  • Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

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