Credentialing Specialist

Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of providers for both Outpatient and ABA providers.

Track progress of outstanding applications and report progress to Client Managers / Team Leaders.

Monitor and update provider portals to ensure accurate information is visible.

Keep current provider records electronically in Credentialing software, electronic provider folders, and in provider hard copy folders.

Assist in obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc.

Prepare professional communication to providers, payers, and facilities.

Understand how provider credentialing impacts billing, contracts, and EDI.

Investigate solutions to problems and determine the best course of action.

Communicate clearly and professionally with team members, payers, and credentialing representatives.

Must be able to process the ERA & EFT application.

Must have brief knowledge of Govt., MCOs, and commercial Insurances enrollments.

Job Specification

EXPERIENCE REQUIRED :

Minimum 2 years of experience.

Leadership and management skills.

Good communication and research skills.

Joining : Immediate joining within a week.

Hospital & Health Care - Rawalpindi, Pakistan.

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