Credentialing Specialist

Credentialing Specialist

Experience- 3 to 4 years Proven

location- J Block, LDA Avenue One Lahore

Salary: 100K to 120K

Timing- US EST- 6 pm to 3 am in summer and 7 pm to 4 am in winter

Roles and Responsibilities

• Initiate enrollment with insurance companies for all new providers
• Maintain the timelines on enrollment schedules, communicate with billing and the office managers on updates as needed and explain payer information requirements
• Work closely with physicians and office mangers to obtain missing documentation on providers for enrollment with insurance companies
• Follow-up with insurance companies for provider participation status
• Complete re-credentialing for existing providers
• Able to effectively communicate with team members, billing staff and insurance companies
• Retain detailed and accurate lists of insurances for which clients participate
• Performs other related duties, which may be inclusive, but not listed in the job description
• Complete provider credentialing/contract applications with third-party carriers and government health plans.
• Review provider credentialing and contracting information to ensure completeness and accuracy.
• Monitor applications and follow-up in a timely manner.
• Document, maintain and crosscheck client credentials in multiple databases, including CAQH and other third-party databases, as applicable.
• Create, update and track provider information in the internal credentialing system to ensure that credentials are completed timely and correctly.
• Meet or exceed required timeframes for provider communications, enrollments, and follow-ups.
• Maintain quality working relationships with internal and external customers.
• Collect, Submit, & Track all necessary documentation.
• Process re-credentialing for existing clinicians as required by individual payers.
• Maintain a current, accurate database of all clinicians’ credentialing / licensure status, needs, expirations, issues, etc. Share with internal staff as applicable.
• Communicate & Coordinate with all levels of internal staff & external stakeholders to ensure timely & consistent qualification is met & maintained.
• Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.
• Investigate and resolve any issues that arise during the approval process.
• Under the direction of leadership, assist with site level enrollments or changes to contract.
• Other duties as deemed necessary.

Contact HR.

hr@thequestmbs.com 03324641025

Pay: Rs100,000.00 - Rs120,000.00 per hour

Expected hours: 45.0 per week

Work Location: In person