About This Role
This role involves managing the credentialing process for medical providers, ensuring all necessary documentation and applications are up-to-date and accurate. The specialist will maintain provider files, complete credentialing and revalidation requests, and work to resolve any related denials or authorization issues.
Responsibilities
- Maintain individual provider files with up-to-date information for governmental 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
- Help medical providers apply for or renew medical professional licenses, DEA, and Controlled Substance registrations
- Complete revalidation requests issued by government payers
- Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
- Complete re-credentialing applications for commercial payers
- Work closely with the Revenue Cycle Director and 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
Requirements
- 2-3 years prior experience in US Medical Credentialing
- Minimum Bachelor’s Degree in Commerce, Finance, Arts, Pharmacy, Microbiology, or a related field
- Excellent English communication skills, both verbal and written; spoken English with American pronunciation is desired
- Good command over Excel, Word, and health industry-related software tools
- Excellent organizational and analytical skills, and adaptability to changing situations
- Proven knowledge of basic medical terminologies such as coding (ICD10, CPT & HCPC)
- Experience in managing the overall revenue cycle
- Knowledge about data conversion and EMR implementation
- Knowledge about enrollment & credentialing and EDI & ERA/EFT setup
Important Details
- Schedule: 6:00 PM to 3:00 AM
About the Company
eServMD Pvt Ltd is a service provider company based in Islamabad, Pakistan, offering services to US-based companies and clients in Electronic Medical Records (EMR), Medical Practice Management, Medical Billing, Real Estate, Accounts & Finance.