Website:
healthcareinformatics.co.in
Job details:
Company Description
Healthcare Informatics Pvt. Ltd. (HIPL), established in 2006, is a leading provider of healthcare services specializing in Knowledge Services and Outsourcing/Back-office solutions for the healthcare industry. HIPL supports medical billing companies, clinics, hospital billing, and medical records departments with services like Medical Transcription, Medical Billing & Coding, and IT support. The company is committed to delivering high-quality healthcare services, focusing on healthcare records management and revenue cycle optimization for hospitals, clinics, and independent physicians.
Role Description
This is a full-time remote role for a Credentialing Specialist (Provider Enrollment) at Healthcare Informatics Pvt. Ltd. The Credentialing Specialist will handle the entire credentialing and re-credentialing processes for healthcare providers. Responsibilities include managing enrollment with Medicare and other payers, tracking provider applications, maintaining accurate records, communicating with insurance companies, and ensuring compliance with regulatory requirements. The specialist will collaborate with providers, clients, and various stakeholders while maintaining a high standard of customer service.
Qualifications
• Manage provider enrollment and credentialing with Medicare, Medicaid, and commercial insurance payers.
• Prepare and submit credentialing and recredentialing applications accurately and within timelines.
• Create, maintain, and update credentialing files for all healthcare providers.
• Maintain and update Council for Affordable Quality Healthcare CAQH profiles and ensure quarterly attestations are completed.
• Utilize PECOS (Provider Enrollment, Chain and Ownership System) for Medicare enrollments and reassignments (855I, 855R, 855B).
• Perform regular follow-ups with insurance payers to track application status and resolve pending issues.
• Monitor and maintain provider credentials including State Licenses, DEA, NPI, Malpractice Insurance, and Board Certifications.
• Coordinate with internal teams to ensure providers are active with payers and linked for claim submissions.
Required Candidate Profile
• Minimum 5 years of experience in Provider Enrollment and Credentialing.
• Experience working on the provider side or with a medical billing company.
• Strong knowledge of Medicare, Medicaid, and Commercial payer enrollments.
• Hands-on experience with PECOS and CAQH.
• Experience handling individual and group provider enrollments.
• Strong communication, organization, and follow-up skills.
• Proficient in MS Office (Excel, Word, Outlook).
• Ability to manage multiple providers and payer applications simultaneously.
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