Provider Insurance Credentialing Specialist

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🏢 Company Description

RevGroMD enables growth in healthcare practice by providing expert revenue solutions. We navigate the complexities of provider enrollment, revenue cycle, and market dynamics so that you can focus on providing exceptional care. Our trio of essential services includes Insurance Credentialing, Revenue Cycle Management, and targeted Marketing Services to fortify your healthcare practice or facility.

🎯 Role Description

This is a full-time remote role for a Provider Credentialing Specialist based in Mohali. The Provider Credentialing Specialist will be responsible for managing the provider enrollment process, ensuring accurate and timely completion of credentialing applications, and maintaining credentialing files. They will also collaborate with internal teams and insurance companies to resolve any credentialing issues and ensure compliance with Medicare and other regulatory requirements.

🔍 Key Responsibilities

✔ Review and authenticate credentials, qualifications, licenses, certifications, and other relevant documents submitted by individuals or organizations.

✔Take care of the provider's CAQH account, PECOS (Medicare Account), & application enrollment with Medicare & Medicaid.

✔ Complete and submit applications to insurance payers (Medicare, Medicaid, commercial payers).

✔ Track application progress and follow up regularly with insurance companies regarding provider enrollment status until completion.

✔ Maintain and update credentialing files and databases.

✔ Ensure compliance with HIPAA and industry regulations and standards.

✔ Collaborate with internal teams to resolve credentialing-related issues.

📌 Qualifications & Skills

✔ 1-5 years of hands-on experience in provider credentialing or payer enrollment

✔ Familiarity with CAQH, NPPES, PECOS, and payer portals

✔ Knowledge of end-to-end provider enrollment process

✔ Knowledge of Medicare, Medicaid, and commercial insurance enrollment processes

✔ Excellent written and verbal communication skills

✔ Strong organizational skills and attention to detail

✔ Proficiency with Google Workspace, credentialing software/tools, and project management tools

Why Join RevGroMD

✅Be part of a mission-driven team simplifying healthcare operations

✅Growth opportunities and skill development

✅Flexible work environment with ownership of your work

✅Make a direct impact on revenue cycle performance and provider satisfaction