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Credentialing Specialist

Credentialing Specialist

ConfidentialBengaluru / Bangalore, India
6 days ago
Job description

Role -

Credentialing Specialist / Analyst will be responsible for meeting the set SLAs, viz, productivity, quality and attendance.

Requirements -

  • Education : Graduates / Diploma holders
  • Knowledge : US Medical billing, provider credentialing
  • Experience : 1 to 2 years for Analyst and 3 years – 5 years for specialist
  • Knowledge of provider credentialing and contracting with government and commercial Insurance plans
  • Minimum 1 year of experience in submitting applications for contracting and credentialing with Insurance plans
  • Excellent computer skills including Excel, Word, and Internet use
  • Plans and priorities to meet deadlines.

Key Responsibilities -

  • Maintain individual provider files and group information to include up to date information needed to complete the required government and commercial payer credentialing applications.
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
  • Collect and maintain files in relation to credentialing of network providers including current provider licenses, DEA certificates, malpractice insurance, board certifications, and other pertinent forms need for enrolment
  • Maintain internal trackers to ensure all information is accurate and logins are available and legible
  • Update each provider's CAQH database file timely according to the schedule published by CMS
  • Complete revalidation requests issued by government payers

    • Skills Required

    Word, Excel

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