Qway Technologies Hiring for Credentialing Caller – US Healthcare

Industry: US Healthcare / Medical Billing
Experience: 1–5 Years
Location: Guindy, Chennai
Employment Type: Full time
Shift: US Night Shift

Job Description-

We are looking for experienced and dedicated Credentialing Callers with 1–5 years of experience in US Healthcare Credentialing and Provider Enrollment. The candidate should have good knowledge of insurance provider credentialing, payer enrollment, re-credentialing, and follow-up processes.

The ideal candidate should be responsible for coordinating with insurance companies, tracking provider applications, verifying credentialing status, and ensuring timely completion of provider enrollment processes.

Roles and Responsibilities

1. Provider Credentialing

- Handle end-to-end provider credentialing processes for US healthcare providers.
- Collect, verify, and maintain provider demographic and professional information.
- Coordinate with physicians and healthcare providers to obtain required documents.
- Verify licenses, certifications, education, work history, and malpractice insurance details.
- Ensure provider credentialing applications are complete and accurate.

2. Insurance Payer Enrollment

- Contact US insurance companies to check provider enrollment status.
- Follow up with commercial insurance payers, Medicare, and Medicaid.
- Handle new provider enrollment and payer registration.
- Track pending, approved, rejected, and returned applications.
- Ensure timely completion of payer enrollment activities.

3. Credentialing Follow-up





- Make outbound calls to insurance companies and credentialing departments.
- Follow up on pending credentialing and enrollment applications.
- Obtain application status, reference numbers, and expected completion timelines.
- Identify missing documents and application discrepancies.
- Maintain regular follow-ups until final approval.

4. Re-Credentialing and Revalidation

- Manage provider re-credentialing and revalidation activities.
- Track provider credentialing expiration dates.
- Ensure timely renewal of licenses, certifications, and insurance documents.
- Follow up with payers for re-credentialing approvals.
- Maintain updated provider records.

5. Provider Data Management

- Maintain accurate provider information in credentialing databases.
- Update NPI, Tax ID, practice addresses, specialties, and contact details.
- Maintain CAQH provider profiles and ensure information is up to date.
- Verify provider participation and network status with insurance companies.
- Ensure accuracy of credentialing documentation.

6. CAQH and NPI Management

- Work on CAQH ProView profile maintenance and attestation.
- Verify National Provider Identifier (NPI) details.
- Update provider demographic and practice information.
- Coordinate CAQH authorization and document uploads.




- Track CAQH profile completion and attestation status.

7. Documentation and Reporting

- Maintain detailed follow-up notes and credentialing status updates.
- Prepare daily and weekly credentialing reports.
- Track applications through submission, processing, and approval.
- Identify delays and escalate issues to the appropriate teams.
- Maintain confidentiality of provider and healthcare information.

Required Skills and Qualifications

- 1–5 years of experience in US Healthcare Credentialing / Provider Enrollment.
- Knowledge of US healthcare provider credentialing processes.
- Experience in insurance payer enrollment and follow-up.
- Familiarity with Medicare, Medicaid, and Commercial Insurance.
- Knowledge of CAQH, NPI, and provider enrollment procedures.
- Good understanding of provider licensing and credentialing documentation.
- Excellent verbal and written communication skills.
- Hands-on experience in end-to-end provider credentialing.
- Knowledge of PECOS and Medicare enrollment.
- Experience with CAQH ProView.
- Understanding of re-credentialing and provider revalidation.
- Experience handling outbound calls to US insurance companies.
- Credentialing application follow-up accuracy.
- Timely completion of provider enrollment.
- Application approval and turnaround time.
- Quality of documentation and status updates.

Interested candidates can apply for

Candidates can apply for this job - (phone hidden) / [email protected]

Benefits:

- Provident Fund

Work Location: In person

📌 Credentailing Calling (Chennai)
🏢 QWay Technologies Private
📍 Chennai