Job Overview

We are seeking a proactive, detail-oriented, and organized Medical Credentialing Specialist with experience in U.S. healthcare insurance credentialing, CAQH setup, and NPI registration. The ideal candidate will be a self-starter who can work independently, ensuring efficient credentialing processes for our providers, especially those specializing in Mental and Behavioral Health. This role requires the ability to work U.S. Central Time Zone hours and prior experience working U.S. hours. Familiarity with telehealth credentialing is a plus but not required.

Key Responsibilities

• Provider Credentialing and Enrollment:
• Independently complete credentialing and re-credentialing applications for providers, ensuring timely submission and accuracy in documentation.
• Manage provider enrollment with U.S. healthcare insurance companies, maintaining up-to-date records for all contracted payers.
• Oversee applications for CAQH setup and maintenance, ensuring all profiles remain current and accessible to authorized insurance companies.
• NPI Registration and Maintenance:
• Obtain new NPIs as needed for providers and ensure compliance with all regulatory requirements.
• Monitor and update NPIs to align with organizational and provider changes.
• Documentation and Compliance:
• Organize and verify necessary documentation, including state licenses, DEA certifications, board certifications, and insurance details.
• Stay current with regulatory changes and payer requirements for credentialing in Mental and Behavioral Health specialties.
• Coordination and Communication:
• Act as the point of contact for providers, insurance companies, and internal teams to address credentialing issues and facilitate information sharing.
• Communicate with insurance payers to resolve any credentialing issues that impact provider participation and reimbursement.
• Data Management and Reporting:
• Maintain provider credentialing records in our internal systems, ensuring accuracy and completeness.
• Generate reports and status updates for management on credentialing timelines, pending applications, and re-credentialing needs.
• Telehealth Credentialing (Preferred):
• Experience credentialing providers for telehealth services across various payers and states is preferred but not required.

Qualifications

• Experience: Minimum 3 years of experience in healthcare provider credentialing, preferably with U.S. healthcare insurance companies. Prior experience in Mental and Behavioral Health credentialing is a plus.
• Hours: Must be able to work U.S. Central Time Zone hours. Prior experience working U.S. hours is required.
• Self-Starter: Ability to work independently, take initiative, and manage tasks with minimal supervision.
• Education: Bachelor’s degree in healthcare administration, business, or related field preferred but not required.
• Knowledge of Credentialing Systems: Proficiency with CAQH, NPI databases, and other relevant credentialing systems.
• Technical Skills: Comfortable using electronic health record systems, credentialing software, and Microsoft Office Suite.
• Communication Skills: Strong written and verbal communication skills, with the ability to effectively interact with providers, payers, and internal teams.
• Attention to Detail: Highly organized, detail-oriented, and able to manage multiple providers’ credentialing needs with precision.

Preferred Experience

• Did credentialing for Illinois state can be added advantage
• Experience in Mental and Behavioral Health credentialing.
• Familiarity with telehealth provider credentialing.
• Knowledge of current healthcare regulations and compliance standards in credentialing processes.

Benefits

• Competitive compensation.
• Flexible, remote work environment.
• Opportunity to work with a dedicated team focused on improving access to quality healthcare.

Job Type: Full-time

Pay: ₹50,000.00 - ₹55,000.00 per month

Experience:

• credentialing: 3 years (Preferred)

Shift availability:

• Overnight Shift (Required)

Work Location: Remote