8 Caqh Jobs

Responsibilities: * Verify patient eligibility & enrollment * Manage credentialing process from start to finish * Ensure accurate Medicaid verification & billing compliance Health insurance

As a Credentialing Specialist, you will play a crucial role in our healthcare operations team by managing end-to-end credentialing and re-credentialing processes. Your primary responsibility will be ensuring the efficiency of the revenue cycle by handling tasks such as maintaining accurate provider data, tracking expirables, and collaborating with billing teams. You will be responsible for interacting with insurance companies and regulatory bodies to follow up on application statuses and resolve any issues that may arise. Additionally, you will work closely with the RCM team to support eligibility, pre-authorization, and claim submission tasks. Your attention to detail and organizational skills will be essential in maintaining timely renewals and accurate credentialing status. To succeed in this role, you should have a minimum of 2 years of experience in provider credentialing and RCM processes. Familiarity with the U.S. healthcare system, medical billing cycles, and denial management is also required. Excellent communication skills, both verbal and written, are essential, along with the ability to multitask, prioritize, and manage time effectively. Proficiency in MS Office and credentialing software/tools is a must. This is a full-time position with night shift hours (06:30 PM - 03:30 AM) from Monday to Friday. The work location is in person. In addition to competitive compensation, benefits such as leave encashment, paid time off, and Provident Fund are also provided. If you are a highly organized and detail-oriented individual with a passion for healthcare operations, we would love to have you join our team as a Credentialing Specialist.,

Provider Credentialing (US healthcare medical billing) 1. Collect all the data and documents required for filing credentialing applications from the physicians 2. Store the documents centrally on our secure document management systems 3. Understand the top payers to which the practice sends claim and initiate contact with the payers 4. Apply the payer-specific formats after a due audit 5. Timely follow-up with the Payer to track application status 6. Obtain the enrolment number from the Payer and communicate the state of the application to the physician 7. Periodic updates of the document library for credentialing purposes. Required Candidate profile Desired Candidate Profile: 1. Should have worked as a Credentialing Analyst for at least 3-year medical billing service providers 2. Good Knowledge in Provider credentialing (Doctor side). 3. Good knowledge in clearing house setup - Electronic Data Interchange setup (EDI) - Electronic Remittance Advice Setup (ERA) - Establish Insurance Portals (EFT) 4. Experience in Insurance calling. 5. Good knowledge in filling insurance enrollment applications. 6. Good experience in CAQH, PECOS application. 7. Experience in Medicare, Medicaid, Commercial insurance enrollment. 8. Positive attitude to solve problems 9. Knowledge of generating aging report 10. Strong communication skills with a neutral accent Note: Minimum of 8 to 12 years of Provider Credentialing experience must. Location: Coimbatore (Onsite job) Preference will be given to candidates who can start immediately or with short notice. Candidates who are freshers or have experience in other domains are kindly requested not to apply for this position.

Summary Green Apples is looking for driven, dedicated and experienced Credentialing & Enrolment professionals, proficient in US healthcare, who are comfortable working in evening shift starting at 4pm IST. Noida based Company, currently working from home. Local candidates from Delhi-NCR only need to apply. Description Hiring multiple candidates with 1 year and more, hands-on working experience in Credentialling Candidates with minimum of 1 year experience in Credentialling & enrolment alone only need to apply. Should have knowledge base of end-to-end provider US healthcare credentialing. Should be able to work independently with minimum or no supervision. Should have experience in credentialing with Medicare, Medicaid, their HMOs and Commercial payers. Good experience n CAQH, PECOS application. Tracks expiration dates and maintains current state licenses, DEA certification, malpractice coverage and any other required documents for all providers. Malpractice coverage and any other required documents for all providers. Compiles information and sets up provider files Set up all ERA and EFT enrolments Completes initial provider credentialing applications, monitors applications and follows up as needed. Track all expired provider certification. Initiate re-credentialing application as requested by insurance companies. Collect all the data and documents required for filling credentialing application from the physicians/ clinics Store the documents centrally on our secure document management systems. Strong communication skills in English with a neutral accent. Detail-oriented with excellent follow-up abilities Proficiency in Microsoft office tools Ability to juggle multiple priorities successfully. Willingness to work in the evening shift Qualifications: Graduate/ Masters degree in the related field Capability to converse clearly and precisely with US clients and payers, credentialing department personnel, by phone and email Excellent computer skills Excellent command over English with excellent written and verbal communication skills Excellent management skills Excellent Analytical Skills. Perks and Benefits Perks and Benefits: As per industry standard

Overview: As a Credentialing Executive, you will play a crucial role in ensuring that our healthcare organization maintains compliance with regulatory standards and delivers high-quality care by thoroughly vetting and credentialing healthcare providers Your attention to detail, understanding of healthcare regulations, and ability to build strong relationships will be instrumental in facilitating the credentialing process and maintaining accurate provider databases. Responsibilities: Provider Credentialing: Manage the credentialing process for healthcare providers, including physicians, nurse practitioners, physician assistants, and allied health professionals This involves collecting, verifying, and evaluating provider credentials, licenses, certifications, and other relevant documents to ensure compliance with organizational and regulatory standards. Provider Enrollment: Coordinate provider enrollment with various insurance networks, Medicare, Medicaid, and other payer organizations Complete and submit enrollment applications accurately and in a timely manner to facilitate reimbursement for services rendered by credentialed providers. Database Management: Maintain accurate and up-to-date provider databases, including credentialing files, licensure information, malpractice insurance coverage, and other pertinent documentation Ensure that all provider information is entered and updated in credentialing software systems or databases. Regulatory Compliance: Stay abreast of changes in healthcare regulations, accreditation standards, and payer requirements related to provider credentialing and enrollment Ensure that credentialing processes align with industry best practices and regulatory guidelines, including those set forth by organizations such as NCQA, URAC, and CMS. Provider Relationships: Develop and maintain positive relationships with healthcare providers, medical staff, and internal stakeholders to facilitate the credentialing process Serve as a liaison between providers and credentialing committees, addressing inquiries, resolving issues, and providing support as needed. Quality Assurance: Implement quality assurance measures to monitor the effectiveness and efficiency of the credentialing process Identify areas for improvement and implement corrective actions to enhance process efficiency, accuracy, and compliance. Audits and Reviews: Prepare for and participate in internal and external audits, reviews, and accreditation surveys related to provider credentialing and enrollment Ensure that credentialing documentation and processes meet audit requirements and support organizational compliance. Training and Education: Provide training and education to healthcare providers and staff on credentialing policies, procedures, and best practices Foster a culture of compliance and accountability throughout the organization by promoting awareness of credentialing requirements and expectations. Qualifications: Bachelor's degree in healthcare administration, business administration, or a related field (Master's degree preferred). Certification in healthcare credentialing (e.g., CPCS, CPMSM) highly desirable. Minimum of 3-5 years of experience in healthcare credentialing and provider enrollment, preferably in a managed care. In-depth knowledge of healthcare regulations, accreditation standards, and payer requirements related to provider credentialing and enrollment (e.g., NCQA, CMS, Medicare). Proficiency in credentialing software systems (e.g., CAQH, NAMSS) and Microsoft Office Suite. Strong analytical skills with the ability to review and interpret complex credentialing documents and data. Excellent communication, interpersonal, and organizational skills. Detail-oriented with a commitment to accuracy and quality assurance. Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.

Looking for minimum 1 year experince in Provider Credentialing or Provider Enrollment in Voice process Should be aware about CAQH / EFT / ERA or EDA Looking for immediate Joiners , virtual Interview available Contact 8977711182

Job Description The Provider Enrollment is responsible for the timely and accurate enrollment of healthcare providers with government and commercial insurance payers. This role ensures that providers are enrolled correctly and efficiently so that they can bill and receive reimbursement for services renders. The Specialist works closely with the Hospital system and payer organizations to facilitate smooth onboarding and maintain compliance with payer requirements. Role & responsibilities Prepare, submit, and track provider applications for enrollment and credentialing with Medicare, Medicaid, and commercial payers. Assist with creating and maintenance of CAQH profiles. Monitor and follow up on application statuses to ensure timely processing. Communicate with insurance companies and internal stakeholders to resolve issues related to enrollment. Maintain confidentiality and professionalism while performing work tasks. Track and Maintain work production daily. Preferred candidate profile 1-3 years of experience in provider enrollment, credentialing, or medical billing strongly preferred. Knowledge of CMS, Medicaid, and commercial payer enrollment processes. Familiarity with CAQH, NPPES, PECOS, and payer portals. Strong organizational skills and attention to detail Excellent written and verbal communication skills. Ability to manage multiple tasks and meet deadlines. Proficiency in Microsoft Office (Excel, Word, Outlook, Sharepoint) and experience navigating web-based applications Ability to work positively and productively in a fast-paced environment. Accurate typing of 40 WPM is required. Perks and Benefits: Night Shift Allowance Fixed week Offs (Sat-Sun) 2way cab facility (within 25 KM Radius) Incentives plan Walkin Details: Date: 2-May-2025- 25-May-2025 Timings: 11AM to 4PM Contact Person: HR Aishwarya/ 9032212019 Please share your resumes on the below mentioned Mail id: Pyaram.Aishwarya@sutherlandglobal.com Mention HR Aishwarya on your resume Venue: 7th Floor, Divyasree building, Lanco hills, Khajaguda, Manikonda.

Oversee complete credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and ongoing monitoring Compliance with accreditation bodies, government regulations, payer requirements, and organizational policies Required Candidate profile Exp in CAQH, PECOS Exp in Medicare, Medicaid, and Commercial insurance enrolment Maintain accurate records and databases of healthcare providers Good in filling insurance enrollment applications