credentialing assistant

RK Med Pro

Job SummaryThe Credentialing Manager will oversee offshore credentialing operations in Pakistan, ensuring U.S. provider credentialing and recredentialing activities comply with NCQA, CMS, and payer requirements, while managing team performance and audit readiness.Key Responsibilities<ul><li>Lead end-to-end provider credentialing, recredentialing, and Primary Source Verification (PSV)</li><li>Ensure compliance with NCQA standards and delegated credentialing guidelines</li><li>Manage CAQH reviews, licenses, DEA, board certifications, sanctions, and work history checks</li><li>Supervise, train, and evaluate offshore credentialing staff</li><li>Coordinate with U.S. clients, payers, and providers across time zones</li><li>Maintain audit-ready documentation and credentialing reports</li></ul>Required Qualifications<ul><li>Bachelor&rsquo;s degree or equivalent experience</li><li>4&ndash;6+ years of U.S. healthcare credentialing experience</li><li>Strong knowledge of NCQA, CMS, Medicare/Medicaid, and commercial payers</li><li>Excellent English communication and team-management skills</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs300,000.00 per monthWork Location: In person

Credentialing Manager

Hiffey

Claims Med pioneers in Medical Billing for Healthcare providers in the United States. We are looking for fresh, energetic individuals who can not only add value to our firm, but also find endless opportunities in a growing firm. We are currently hiring individuals for our credentialing teams and looking for candidates(Preferably males) who are willing to learn and apply themselves in a short period of time- No Experience required.Job Description: Prepare, submit and track provider credentialing and re-credentialing applications. Maintain accurate provider information in CAQH, NPPES, PECOS and payer portals. Verify provider credentials Ensure compliance Coordinate site visits, address corrections and contract amendments as required by payers Maintain credentialing databases, spreadsheets and audit-ready files. Communicate regularly with providers, practice managers and insurance representatives regarding credentialing status Support facility credentialing and payer enrollment for new locations. Prepare reports on credentialing timelines, approvals, denials, and expirationsRequirements Night shift availability (7pm to 4am) Mondays to Fridays Graduation (required) English Proficiency is mustLocation Shaheed-e-Millat Rd, Karachi Paid training will be provided. Finalists will begin a 3-month probation period and will be re-evaluated before becoming permanent employees. Permanent employees enjoy several performance, and punctuality based bonuses, along with other perks.Please submit your resumes at hr@claimsmed.com and begin your journey of becoming an integral part of the Claims Med family.Job Type: Full-timePay: Rs40,000.00 - Rs45,000.00 per monthWork Location: In person

Credentialing Analyst

claimcare

<ul><li>Ensure ongoing compliance with regulatory standards, such as those set by the National Committee for Quality Assurance (NCQA). specific actions or procedures related to compliance.</li><li>Efficiently perform all credentialing verification and Enrollment aspects with payers, including initial credentialing and re-credentialing to ensure current Enrollment and timely handoff.</li><li>Participate in the development of internal credentialing &amp; Enrollment processes&middot;</li><li>Keep records of licenses, credentials, insurance contracts and other documents of groups and individual providers. &middot;</li><li>Establish a robust monitoring system to track expiring licensures, board certifications, and professional certifications. Implement proactive measures for timely renewals to prevent any lapses.</li><li>Adhere to legal requirements for information release, ensuring compliance with privacy regulations. Clearly communicate the processes for releasing information to agencies and the public, emphasizing the importance of maintaining confidentiality. &middot;</li><li>Use critical thinking skills to conduct Research, follow-up with the Insurance companies.</li><li>Establish and communicate a clear timeline for responding to inquiries from clients, health plans, and internal stakeholders. Implement effective communication channels to ensure timely and comprehensive responses.</li><li>Regularly update and maintain the CAQH profiles of assigned providers. Address any challenges in ensuring the accuracy and completeness of profiles and implement strategies for ongoing profile maintenance.</li><li>Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.</li></ul>Job Type: Full-timePay: Up to Rs150,000.00 per monthWork Location: In person

Behavioral Health Group

<div>Remote Position - Requires Payor Credentialing and Payor Enrollment experience

The Payor Credentialing Specialist is responsible for leading, coordinating, monitoring, and maintaining the payor and provider credentialing and re-credentialing processes. Facilitates all aspects of BHG&rsquo;s payor credentialing including payor enrollments, revalidations, maintenance, license updates, and follow up on payor credentialing related A/R issues. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to payor credentialing and enrollment. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director of Payor Credentialing in conjunction with Chief Revenue Officer.

The key responsibilities of the Payor Credentialing Specialist include but not limited to:

Duties and Responsibilities
<ul>
<li>Prompt and regular attendance at an assigned work location.</li>
<li>Ability to complete or oversee the completion of assigned tasks/projects in a timely manner.</li>
<li>Complete process to enroll and credential facilities as well as providers with insurances; ensure all payor criteria are met.</li>
<li>Leads, coordinates, and monitors the collection, review, and analysis of payor enrollment applications.</li>
<li>Responsible for accuracy and completeness of payor enrollment submissions including supporting documentation.</li>
<li>Follow up with providers and insurances for timely credentialing and enrollment process(es).</li>
<li>Responsible for monitoring application progress and following up with payors as needed until confirmation of credentialing and network load is complete.</li>
<li>Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.</li>
<li>Review, and update if necessary; health plan directories, agencies, and other appropriate entities for current and accurate provider information</li>
<li>Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and enrollment issues as they arise.</li>
<li>Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation.</li>
<li>Enters and maintains accuracy of data input into Credential Stream, PECOS, NPPES, CAQH, Optum, Availity, and other payor portals.</li>
<li>Verify provider accuracy in payor directories.</li>
<li>Provide support with managed care delegated credentialing audits; conduct internal file audits.</li>
</ul>
Regulatory
<ul>
<li>Ensure compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state laws) and policies and procedures in all aspects of the payor credentialing process.</li>
</ul>
Marketing and Outreach
<ul>
<li>Participate in community and public relations activities as assigned.</li>
</ul>
Professional Development
<ul>
<li>Demonstrates the belief that addiction is a brain disease, not a moral failing.</li>
<li>Demonstrates hope, respect, and caring in all interactions with patients and fellow team members.</li>
<li>Establishes and maintains positive, professional relationships in the workplace.</li>
<li>Ability to work independently and under deadlines while handling multiple tasks simultaneously.</li>
<li>Makes decisions and uses good judgment with confidential and sensitive issues.</li>
<li>Maintain professional, calm demeanor with others in stressful or other undesirable situations.</li>
</ul>
Training
<ul>
<li>Attend and complete all required trainings as assigned by Director.</li>
<li>Prompt and regular attendance at an assigned work location.</li></ul> 


Minimum Requirements
<ul><li>The Credentialing Administrator needs at least 3 to 5 years of experience in payor credentialing/enrollment experience.</li>
</ul>
Qualifications
<ul>
<li>Bachelor&rsquo;s degree preferred or comparable work experience.</li>
<li>Current CPCS or CPMSM certification or working towards certifications.</li>
<li>Experience or working knowledge of full credentialing cycles; initial payor credentialing/enrollment, maintenance and revalidation.</li>
<li>Experience or working knowledge of CredentialStream credentialing platform or other credentialing database software.</li>
<li>Excellent attention to detail, problem-solving, critical thinking, and analytical skills.</li>
<li>Strong working knowledge of word processing, spreadsheets, data entry, database experience and other computer related skills.</li></ul> 


In addition to meeting the qualifications, the ideal candidate will embody the following characteristics and possess the knowledge, skills and abilities listed below:
<ul>
<li>Holds a basic understanding of substance use disorder.</li>
<li>The highest ethical and professional standards.</li>
<li>Maintains the strictest confidentiality.</li>
<li>Excellent written and verbal communication skills.</li>
<li>Excellent attention to detail and problem-solving skills required.</li>
<li>Excellent analytical, judgment, and decision-making skills.</li>
<li>Proficient in Adobe, Excel, PowerPoint, Word, Outlook, and other Microsoft Office applications.</li>
<li>Well organized, capable of juggling multiple projects and accustomed to tight deadlines.</li>
<li>Ability to work effectively and independently with both clinical and non-clinical colleagues.</li>
<li>Ability to perform research independently.</li></ul> 


Physical Requirements and Working Conditions
The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.
<ul>
<li>Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes</li>
<li>Vision adequate to read correspondence, computer screen, forms, etc.</li>
<li>Sit for long periods of time, some bending, stooping and stretching</li>
<li>Variable workload, periodic high activity level</li>
<li>Keyboarding for long periods of time</li></ul> 


Disclaimer
The above statements are intended to describe the general nature and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of team members so classified. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed, and this job description may be updated at any time.

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.
Equal Opportunity Employer 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</div>

Payor Credentialing Specialist (remote)

GRMAC Pvt ltd

Job Title: Credentialing Executive (Healthcare Process)Location: Chennai Experience: 1&ndash;5 years Industry: Health Care / Medical ServicesJob Description: Responsible for verifying and processing healthcare professionals&rsquo; credentials, licenses, and documents as per company and client standards. Ensure accuracy and timely completion of credentialing and re-credentialing activities.Key Responsibilities:<ul><li>Collect and verify doctors&rsquo;/providers&rsquo; documents and licenses</li><li>Update and maintain credentialing databases</li><li>Coordinate with healthcare providers and insurance networks</li><li>Ensure compliance with regulatory and organizational policies</li></ul>Requirements:<ul><li>Good communication skills</li><li>Attention to detail</li><li>Basic knowledge of healthcare documentation preferred</li><li>Experienced candidates can apply</li></ul>Job Types: Full-time, PermanentPay: ₹20,000.00 - ₹30,000.00 per monthBenefits:<ul><li>Health insurance</li><li>Provident Fund</li></ul>Work Location: In person

Credentialing Specialist (Healthcare Process)

Round Table Medical Consultants LLC

<div>The Credentialing/Contracting Specialist will be responsible for all tasks associated with physician privileging and medical staff membership credentialing. The Specialist will communicate with outside agencies, including physician offices, hospitals, insurance carriers, and other healthcare agencies as required.
<ul><li>Minimum Education: High School Diploma/G.E.D.
</li><li>Minimum 3+ years of experience with physician and facility credentialing is required.
</li><li>Experience with insurance carrier credentialing preferred</li><li>
Maintain strong skills in diplomacy, professionalism, and trustworthiness.
</li><li>Strong communication skills in both oral and written.
</li><li>Positive attitude, Team Player, and ability to work independently.
</li><li>Knowledge of EPower and Centricity is a benefit.</li><li>
Strong working knowledge of computers and Windows PC applications, such as Excel and Word, including the ability to learn new computer systems and applications.</li><li>
Ability to manage multiple priorities and projects.
</li><li>Detail-oriented with a desire to produce work with 100% accuracy.
</li><li>Excellent analytical and problem-solving skills.</li></ul>
JOB RESPONSIBILITIES/ DUTIES<ul><li>
Responsible for internal credentialing of all providers in the practices and external consultants coming to the practices.
</li><li>Responsible for credentialing facilities with insurance carriers.
</li><li>Responsible for maintaining complete and up-to-date credentialing files for each provider and every practice to internal defined standards.
</li><li>Meets with providers to gather, review, and provide guidance on completion of credentialing packets.
</li><li>Coordinates the accurate input of physician information into CAQH, Medicare, Medicaid, and the internal tracking database.</li><li>
Responsible for the processing of accurate completion of Texas Standardized Credentialing Applications in MS Word files for each physician.
</li><li>Responsible for the input of physician documents into the database and the proper maintenance of all necessary documents mandated by the organization.
</li><li>Continuously verifies the status of CVs, provider licenses, DEA, DPS certificates, and specialty certificates; alerts leadership on any expirables not obtained and any provider who is not responding to open requests.</li><li>
Continuously tracks renewals of provider licenses, DEA, DPS, and ACLS certificates.
</li><li>Maintains record-keeping on providers&rsquo; CMEs and follows up with them to receive the CMEs they have completed.</li><li>
Ensures providers&rsquo; information is forwarded to the appropriate channels within the organization on a mandated basis.</li><li>
Completes various provider applications and tracks the status of applications once submitted to all insurance carriers.</li><li>
Maintains Contact information and provides it to leadership upon hiring of new providers and completion of the credentialing process.</li><li>
Updates the appropriate departments on the status of providers&rsquo; credentialing on Managed Care/Insurances.</li><li>
Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.</li><li>
Perform other duties as assigned by the Director of Operations as necessary.
</li></ul>WORKING CONDITIONS
<ul><li>The employee will be exposed to working conditions commensurate with a traditional office environment.</li><li>
The employee must be able to lift and/or move using proper body mechanics and agree to ask for assistance if required.</li><li>
While performing the duties of this job, the employee is frequently required to stand, walk, and sit.</li><li>
Must submit to random drug screenings.</li></ul>
Full-Time Benefit Perks:<ul><li>
Health benefits start on the first of the month after hire</li><li>
Medical, dental, and vision plans with sliding-scale premiums</li><li>
100% coverage for preventive health services</li><li>
HSA and FSA options available</li><li>
Company-paid life insurance and long-term disability</li><li>
401(k) with contributions starting after 30 days</li><li>
100% match on the first 4%,
</li><li>Full vesting after 3 years</li><li>
Access to exclusive employee discounts on travel, fitness, shopping, and more</li><li>
Paid Time Off</li><li>
Paid Holiday</li></ul>
Join us and make a significant impact on our company&rsquo;s success in reaching our target audience and driving business growth.</div>

CREDENTIALING SPECIALIST

MeshSquare

Job description:Position: Senior Credentialing SpecialistCompany: Meds NexusLocation: Office # 1st, 5th Floor, Gold Mark Plaza, Asghar Mall Rd, Asghar Mall Scheme, Rawalpindi, Punjab 46000Job Timing: 06:00 PM To 03:00 AM (EVENING SHIFT)Job Type: Night ShiftExperience Required: 2-3 yearsPosition Available: 2Special Note: This job is not for fresh candidates.About Us:Meds Nexus is a leading medical billing company based in Rawalpindi, dedicated to streamlining healthcare financial processes. We are actively seeking a detail-oriented and motivated individual to join our Credentialing team as a Senior Credentialing Specialist.Key Responsibilities:- Accurately complete credentialing and reappointment applications for Outpatient and ABA providers.- Track progress of applications and report to Client Managers/Team Leaders.- Monitor and update provider portals for accurate information.- Maintain current provider records electronically and in hard copy folders.- Assist in obtaining required documentation from providers.- Prepare professional communication to providers, payers, and facilities.- Understand the impact of credentialing on billing, contracts, and EDI.- Investigate and determine solutions to problems.- Communicate clearly and professionally with team members, payers, and credentialing representatives.- Process ERA &amp; EFT applications.- Have brief knowledge of Government, MCOs, and commercial insurance enrollments.Salary Package:- Basic: up to Rs.100,000 per monthJob Rewards and Benefits:- Paid Leaves- HR Bonus- Loan Policy- Advance Salary- Yearly Loyalty Rewards- Leave Encashment- Inflation Bonus- Promotion- Increments- Medical (TBD)- Employee Equity Funds Program (EEFP)- Saturday and Sunday Off- Complementary Food (Dinner) &amp; Tea/Green Tea (Two times)How to Apply:If you are ready to contribute to a dynamic team and take the next step in your finance career, please submit your resume and a cover letter outlining your relevant experience to hr@medsnexus.com. Please include &quot;Account Assistant Application&quot; in the subject line.Application Deadline: On an urgent basisMeds Nexus is an equal-opportunity employer. We encourage applications from candidates of all backgrounds and experiences.Contact Information:- Email: hr@medsnexus.com- Phone: 051 889-2889 WhatsApp: 03708892889Job Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthWork Location: In person

Senior Credentialing Specialist (Medical Billing)

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