Contracting and Credentialing Lead

6 days ago

Manila, National Capital Region, Philippines The Auctus Group Full time
Key Responsibilities

The Contracting & Credentialing Team Lead will be responsible for:

  • Conducting follow-up steps until payor approval or completion is obtained.
  • Filing provider practice change notifications and performing follow-up duties until confirmed complete by payors.
  • Updating NPI records according to provider specifications.
  • Enrolling providers in Medicare/Medicaid as prescribed by each program's requirements.
  • Tracking provider licensure and board expirations and ensuring timely processing of CAQH and payor updates.
  • Completing requests for re-credentialing for both providers and facilities.
  • Accepting and processing all requests from payers for credentialing information/updates/new contracts and products.
  • Answering questions and processing requests from staff/providers related to credentialing information.
  • Addressing enrollment disconnects regarding facility and providers.
  • Completing ERA/EFT enrollment, tracking, and filing, clearinghouse (Availity RCM, CAQH, Enroll hub etc.).
  • Maintaining quarterly CAQH mass attestation.
  • Serving as liaison between outside organizations and external customers.
  • Managing the creation/maintenance of Availity, Optum, and Medicare usage by providers and third-party users.
  • Submitting accreditation applications and following up until approval is obtained.
  • Knowledge of licensing application processes across different states.
  • Proficiency in creating Group NPI (GNPI) and Individual NPI (INPI) through NPPES.
  • Familiarity with Modio, Pipedrive, and LastPass is a plus.
  • Experience in submitting hospital privileges/initial appointment applications and managing follow-ups until approval.
  • Experience in submitting and tracking DEA applications until approval.
  • Experience in maintaining the Provider's CAQH.

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