Position: U.S. Insurance PLA Code Credentialing Consultant

Employment Type: Part-Time, as needed

Location: Remote

Experience: 3 years preferred

Industry: Healthcare / Clinical Laboratory / Medical Billing & Credentialing

Hourly Rate Range: INR 1000-1500 per hour

About the Role: We are seeking an experienced consultant with in-depth knowledge of US insurance credentialing processes and PLA (Proprietary Laboratory Analyses) code credentialing. We are adaptable with your time for these consultation hours, and we can accommodate these consultation hours based on your availability, if you are already working on a routine schedule. Our team has extensive experience with traditional laboratory and insurance credentialing processes; however, PLA code credentialing is a new area for us, and our team needs guidance on the PLA code credentialing processes.

Expectations from Consultant:

- Knowledge in end-to-end PLA code insurance credentialing for providers (Medicare, Medicaid, and commercial payers).
- Handle PLA code credentialing and ensure compliance with payer-specific requirements.

· Knowledge in supporting documentation requirements for PLA code approval, including:

- Test description
- Clinical utility
- Medical necessity




- Laboratory information
- FDA/CLIA information, when applicable
- CPT/PLA code documentation
- Published clinical evidence
- Pricing information

· Knowledge in follow up with payers regarding pending PLA code requests and coverage decisions.

Qualifications:

· Proven experience in US insurance PLA codes credentialing (Medicare, Medicaid, Commercial payers).

· Strong understanding of PLA codes and laboratory credentialing requirements.

How to Apply

Please submit Resume/ CV with:

· Years of U.S. healthcare credentialing experience

· List of payers you have worked with

· Experience with clinical laboratory credentialing

· Specific experience with PLA codes

· Examples of PLA/payer projects handled

Please highlight your direct experience with PLA code credentialing/coverage requests. Candidates without U.S. healthcare payer credentialing experience will not be considered.

Email resume and all information to: [email protected]

www.hexamedx.com

Pay: ₹1,000.00 - ₹1,500.00 per hour

Benefits

- Cell phone reimbursement
- Flexible schedule
- Work from home

Work Location: Remote

📌 Consultant – U.S. Insurance PLA Code Credentialing (India)
🏢 Hexamedx
📍 India