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Medical Provider Credentialing Co-Coordinator and EDI Enrollment Specialist

2.00 to 7.00 Years   Hyderabad   21 Apr, 2022
MD MANAGE (INDIA) PRIVATE LIMITED
Job LocationHyderabad
EducationNot Mentioned
SalaryNot Disclosed
IndustryBPO / Call Center
Functional AreaBack Office Operations
EmploymentTypeFull-time

Job Description

    Desired Knowledge & Skill Set:
    • Knowledge of provider credentialing and its direct impact on the practices revenue cycle
      • Excellent computer skills including Excel, Word, and Internet use
      • Detail oriented with above average organizational skills
      • Plans and prioritizes to meet deadlines
      • Excellent customer service skills; communicates clearly and effectively
    Key Responsibilities:
    • Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
    • Maintain internal provider grid to ensure all information is accurate and logins are available
    • Update each providers CAQH database file timely according to the schedule published by CMS
    • Apply for and renew annually all provider licenses; i.e. Professional, DEA, Controlled Substance
    • 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
    • Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
    • Work closely with the RCM 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
    • Set up EDI/ERA and EFT for plans, locations and doctors
    • Communicate with billing staff, management on the status of EDI projects and changes
    • Complete all types of EDI forms (ERA Enrollments, Electronic Claim Enrollments) and submit to correct payers and track the progress on the spreadsheet tracker.
    • Other duties as assigned

Keyskills :
credentialingus healthcare

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