Healthcare Credentialing Specialist

6 days ago

Manila, National Capital Region, Philippines The Auctus Group Full time
Job Description

We're seeking a highly skilled Contracting & Credentialing Team Lead to join our team at The Auctus Group. As a key member of our organization, you'll play a vital role in ensuring the smooth operation of our contracting and credentialing processes.

About the Role:

  • Conduct follow-up steps until payor approval or completion is obtained.
  • File provider practice change notifications and perform follow-up duties until confirmed complete by payors.
  • Update NPI records according to provider specifications.
  • Enroll providers in Medicare/Medicaid as prescribed by each program's requirements.
  • Track provider licensure and board expirations and ensure timely processing of CAQH and payor updates.
  • Complete requests for re-credentialing for both providers and facilities.
  • Accept and process all requests from payers for credentialing information/updates/new contracts and products.
  • Answer questions and process requests from staff/providers related to credentialing information.
  • Address enrollment disconnects regarding facility and providers.
  • Complete ERA/EFT enrollment, tracking, and filing, clearinghouse (Availity RCM, CAQH, Enroll hub etc.).
  • Maintain quarterly CAQH mass attestation.
  • Serve as liaison between outside organizations and external customers.
  • Manage the creation/maintenance of Availity, Optum, and Medicare usage by providers and third-party users.
  • Submit accreditation applications and follow 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.

Qualifications:

  • Ability to assess problem areas and address them effectively.
  • Time management skills, including managing one's own time and the time of others.
  • Excellent written and verbal communication skills are essential for success in this position.
  • Working towards serving clients' needs is a primary goal.
  • Strong organizational and communication skills are required at all levels, both verbally and in writing.
  • Attention to detail is crucial.
  • Problem-solving skills, including addressing, tracking, and solving problems.
  • Ability to multitask in a fast-paced environment.
  • Ability to work full-time hours during regularly scheduled business hours and additional work hours as needed.
  • Ability to work from home with integrity.

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