Credentialing Specialist, US Healthcare

Role:

Credentialing Specialist, US Healthcare

Location:

Pune/Mumbai/Nagpur (Work from Office)

(Address details mentioned below)

Company Profile:

First Insight is a software product development and revenue cycle management company based in Portland, Oregon (USA). It has its India development and service delivery centres in Pune, Mumbai and Nagpur. Its expertise and domain
lies in healthcare and insurance. Its a forward thinking, visionary company that provides high quality software solutions, services, support and training to nearly a thousand optometric and ophthalmic practices in the United States. It has carved a niche in the healthcare industry with its practice management and electronic health records software, support, e- commerce solutions and revenue cycle management services.

To know more about First Insight, please visit @ www.first-insight.com

Following would be the Duties/Responsibilities for Credentialing Specialist:

• Maintain individual provider files to include up to date information needed to complete the required federal and commercial payer credentialing applications.
• Maintain an internal provider grid to ensure all information is accurate and logins are available.
• Update each provider's CAQH database file timely according to the schedule published by CMS.
• Tracks expiration dates and maintains current state licenses, DEA certification, malpractice coverage and any other required documents for all providers.
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
• Track all expired provider certification. initiate re-credentialing application as requested by insurance companies.
• Follow up with providers for missing information or documents.
• Complete revalidation requests issued by federal payers.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers.
• Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• Streamline the credentialing process by efficiently collecting all necessary documentation, including accreditation, membership, and facility privileges (e.g., License, NPI letter).
• Guide and support providers in completing payer forms, ensuring strict compliance with payer expectations.
• Address provider inquiries regarding the progress of the credentialing process promptly and professionally.
• Proactively notify clients of new regulations, impending certificate expirations, reapplications, and any deficiencies in credentialing requirements.

Qualifying Criteria:

• At least 1+ year of experience in Credentialing process in US Healthcare (End to End RCM Process)
• Ability to multi-task
• Good organization skills demonstrating the ability to execute timely follow-ups
• Willingness to be a team player and show initiative where needed
• Ready to work in night shifts
• Excellent oral and written communication skills

Salary: Remuneration will be at par with the best industry standards ; will not be a constraint for the right candidate.

Perks & Benefits :

• Attractive Incentives Plan
• Travelling Allowance
• Mediclaim
• Monthly Rewards

Interested Candidate can also share their resumes directly to the recruiters below:
Rohit Ghate - 7888025217

rohitghate@first-insight.com

Address details:

Registered Office Address- Pune:
First Insight Software Solutions (I) Pvt. Ltd.,
2nd Floor, Server Space, AG Technology Park,
Off ITI Road, S. No.127/1A, Plot No.8,
Aundh, Pune 411 007

Mumbai:
Unit No. 302, 3rd Floor,
New Technocity, Plot No. X-4/5A,
TTC Industrial Area,
Mahape MIDC,
Navi Mumbai - 400 710

Nagpur:
Unit No. 201, 2nd Floor, Wing - C,
VIPL IT Park, Plot No. 28,
MIDC IT Park, Gayatri Nagar Road,
Parsodi, Nagpur - 440 022