Job Title: Credentialing Specialist

Department: Credentialing and Enrollment

Job Purpose and Position Overview:

Team Leader responsible for the performance, productivity and effective management of team members of Credentialing. He would ensure that the providers of a group are properly licensed and certified as mandated by state and federal regulations to credential & contract them with insurance carriers. The Team Leader would report to Asst. manager & is responsible to maintain smooth client relationship.

Specific Job Duties & Responsibilities:

1. List key Duties & Responsibilities

1. Completion and submission of provider enrollment applications to payers

- Update mailing/physical address.

3. Registration of payers’ provider web portal access.

4. Maintenance of documentation and reports regarding provider enrollments in process.

5. Retain records related to completed provider enrollments

6. Maintain provider enrollment information within the credentialing database.

7. Interact with plan representatives by phone or email to provide appropriate and timely response to inquiries and concerns regarding provider.

8. Respond to client inquiries regarding status of applications received.

9. Proactive follow up with insurance plans to monitor status of provider applications.

- Resolve enrollment application deficiencies.

2. List of general Duties/Responsibilities

1.



Maintain strict confidentiality of information as per current HIPAA requirements.

2. Collaborate with leadership and teammates on process improvement.

3. Get tasks done by using all of the resources available.

- Actively Participate in client and team meetings.

5. Manage credentialing work orders, tickets to ensure all established time frames for completing work and projects are met.

6. Monitor provider credentials and communicate to managers to ensure providers remain up to date with state and/or federal regulations

- Audit new staff’s work and give feedbacks.

3. Daily Routine:

1. Complete work orders assigned through tickets and emails.

2. Follow up with the Payers to obtain the status of credentialing application.

3. Work on pending/in process service tickets & project tickets.

4. Weekly routine:

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- Credentialing meeting with team.

5. Quarterly Routine:

- Completion of Rocks

6. Qualifications:

- Any Degree

2. Should have minimum 4+ years of experience in Medical billing.

3. Should have worked in various specialties and be a motivational mentor.

- Good written and verbal communication skills.
- Valuable Typing skills.
- Regular attendance.

7. Measures of Performance:

1. Performance measured by productivity & Quality.

8. Supervisory Responsibilities:

- Audit new staff’s work and give feedbacks.

9. Training Requirements:

- Credentialing Activities

📌 Senior Executive (Chennai)
🏢 Billed Right HealthCare Solutions Private
📍 Chennai