Credentialing Specialist

• 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: Rs60,000.00 - Rs100,000.00 per month

Work Location: In person