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    Credentialing Specialist - Mumbai, India - Go Lean Health

    Go Lean Health
    Go Lean Health Mumbai, India

    1 week ago

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    Description

    PrimaryResponsibilities:

    1.Credentialing and Recredentialing: Manage theprocess of initial credentialing and recredentialing for healthcareproviders. This includes verifying education training residencylicenses and boardcertifications.

    2. DatabaseManagement: Maintain accurate and uptodate recordsof healthcare providers credentials using healthcare informationsystems like Athena Health. Ensure that all data is securely storedand easily accessible for verification and compliancepurposes.

    3. Insurance Processing:Liaise with insurance companies to ensure thathealthcare providers are properly registered and approved to offerservices covered by insurance. This involves submitting detailedinformation and documentation to insurance providers and addressingany issues or discrepancies that mayarise.

    4. RegulatoryCompliance: Ensure that all credentialing activitiescomply with federal and state regulations as well as standards setby healthcare accreditation organizations. Stay updated on changesin regulations and accreditationstandards.

    5. Provider Support:Serve as the primary point of contact for healthcareproviders throughout the credentialing process. Provide guidanceand assistance to providers to ensure that they complete allnecessary steps efficiently andcorrectly.

    6. Collaboration withHealthcare Facilities: Work closely with hospitalsclinics and other healthcare facilities to ensure that their staffmeets all credentialing requirements. Coordinate with facilityadministrators and human resources departments asneeded.

    Skills andQualifications:

    Expertisein AthenaHealth: Proficient in using Athena Healthscredentialing and provider management modules. Familiarity withnavigating its interface and utilizing its features to manageprovider data andcredentials.

    InsuranceKnowledge: In depth understanding of variousinsurance processes including billing codes insurance verificationand claims processing. Ability to work with multiple insuranceproviders and understand their credentialingrequirements.

    Attentionto Detail: Excellent organizational skills and akeen eye for detail ensuring that all aspects of providercredentialing are accuratelymanaged.

    CommunicationSkills: Strong written and verbal communicationskills for interacting with healthcare providers insurancerepresentatives and facilityadministrators.

    ProblemSolving:Ability to identify and resolve issues that may arise during thecredentialing process including discrepancies in documentation ordelays in insuranceprocessing.

    Education andExperience:

    • A degree inhealth administration business administration or a related field isoften preferred.
    • Previous experience inhealthcare credentialing provider relations or a similar role ishighly valuable.
    • Experience withhospital credentialingapplications.
    • Knowledge andexperience with PECOS for Medicare applications andrecredentialing.
    • Certification in providercredentialing (e.g. Certified Provider Credentialing Specialist(CPCS)) is a plus.

    Working Conditions:

    • This role is virtual allowing for remote work from a homeoffice.
    • It may require flexibility in hours toaccommodate different time zones anddeadlines.

    RemoteWork :

    No

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