Credentialing & Enrollment Executive

Summary

GM Analytics Solutions is looking for a driven, dedicated and experienced Credentialing & Enrollment Executive, proficient in US healthcare, who are comfortable working in Night shift (US time)

Job Description

• Minimum 1+ years experience is required in Medical Billing for US Healthcare mandatory. Should have worked as a credentialing analyst for a least 1 year of medical billing service providers.
• Should have end to end provider US healthcare credentialing.
• Should have experience in CMS 855I.
• 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 in verity credentialing system.
• Maintains verity credentialing software to ensure information is accurate and up to date.
• 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 form the physicians.
• Store the documents centrally on our secure document management systems.
• Understand the top payers to which the practice sends claims and initial contract with the payers.
• Obtain the enrolment number form the payer and communicate the state of the applicate to the physician.
• Good experience n CAQH, PECOS application.
• Experience in Medicare, Medicaid, Commercial.
• Strong communication skills with a neutral accent.
• Proficiency in Microsoft office tools
• Willingness to work the night shift

Education/Experience Requirements:

Qualifications:

• Graduate/Master's degree in the related field
• Ability to coordinate with US clinic and Central billing office in the US to clear all outstanding. Capability to converse clearly and precisely with US counterpart either by phone or by email
• Excellent computer skills
• Excellent written and verbal communication skills
• Excellent management skills
• Excellent Analytical Skills.
• Advanced computer skills in MS Office Suite, pMD soft, Acumen, Athenahealth, and other applications/systems preferred

Salary BOE

GM Analytics and RCO Analytics is an equal opportunity employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, veteran status, or any other protected factor.

Job Type: Full-time

Competency Requirements:

Must possess the following knowledge, skills & abilities to perform this job successfully:

• Broad understanding of clinical operations, front office, insurance and authorizations
• Ability to communicate effectively and clearly with all internal and external customers
• Detail-oriented with excellent follow-up.
• Solutions-minded, compliance-minded and results-oriented.
• Excellent planning skills with the ability to define, analyze and resolve issues quickly and accurately
• Ability to juggle multiple priorities successfully.
• Extremely strong organizational and communication skills.
• High-energy, a hands-on employee who thrives in a fast-paced work environment.
• Familiar with standard concepts, practices, and procedures within the field.
• Ability to work in a fast-paced, result-driven, and complex healthcare setting.
• Ability to meet strict deadlines and communicate timelines
• Takes a sense of ownership
• Capable of embracing unexpected change in direction or priority.
• Highly motivated to solve problems; proven troubleshooting skills and ability to analyze problems by type and severity

Work Environment:

• Extensive telephone and computer usage.
• Use of computer mouse requires repetitive hand and wrist motion.
• Time off restricted during peak periods.
• Regular reaching, grasping and carrying of objects

Role:Healthcare & Life Sciences - Other

Industry Type:BPO / Call Centre

Department:Healthcare & Life Sciences

Employment Type:Full Time, Permanent

Role Category:Healthcare & Life Sciences - Other