Job Description

A

Credentialing Specialist

in

RCM (Revenue Cycle Management)

is a professional responsible for ensuring that healthcare providers are properly credentialed and enrolled with insurance companies, government payers (e.g., Medicare, Medicaid), and other third-party payers so they can receive reimbursement for services rendered.

# Key Responsibilities:

Provider Credentialing:

Collect and verify provider information (licenses, certifications, education, work history). Submit credentialing applications to insurance companies and credentialing bodies. Ensure compliance with regulatory and payer-specific requirements.

Enrollment & Re-enrollment:

Manage payer enrollment processes to ensure providers are active and eligible for reimbursement. Track and complete re-credentialing and re-enrollment before expiration.

Data Management:

Maintain accurate records of provider credentials in systems like CAQH, PECOS, or payer portals. Update credentialing databases and ensure all documents are current.

Compliance & Auditing:

Ensure all credentialing activities comply with NCQA, CMS, and JCAHO standards. Prepare for and support internal/external audits.

Communication & Coordination:

Liaise between providers, insurance companies, and billing teams. Resolve issues related to credentialing or payer enrollment that impact billing or reimbursement.
# Required Skills & Qualifications:

Knowledge of RCM processes and healthcare insurance systems. Familiarity with CAQH, NPPES, PECOS, and payer-specific portals. Strong attention to detail and organizational skills. Experience with EMR/EHR and credentialing software (e.g., Modio, Verity). Understanding of HIPAA and credentialing compliance standards.
Please share your resume to ssangar@scale-healthcare.in

Job Types: Full-time, Permanent

Pay: ₹300,000.00 - ?600,000.00 per year

Benefits:

Provident Fund
Schedule:

Night shift
Work Location: In person