Credentialing Analyst

Rawalpindi 30,000 - 50,000 PKR

Job Description

Job Description

- Setting up and maintaining provider information in online credentialing databases and system

- Upon receipt of notification from On Boarding / Account Team from US, initiate the provider enrollment process. Enter all provider information obtained via the client intake form in database and generate all necessary payer application forms.

- Conducting reimbursement enrollment to ensure that all providers are able to bill for services on a timely basis.

- Ensuring practice addresses are current with health plans, agencies and other entities

- Completing provider credentialing and recredentialing applications; monitoring applications and follows-up as needed.

Maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.

- Maintaining direct communication with Practice manager/client to ensure the appropriate and timely enrollment of their providers. Escalating issues that require additional attention before they become a major problem.

- Communicating with insurance carriers regarding receipt of applications, statuses of applications, fee negotiations, authorized services, effective date and required attachments/documents receipts and the offer letter/approved letter copy with provider manual/policy.

- Serving as liaison with the Marketing/on boarding Department, ensuring complete and accurate provider information in the provider database for use in provider directories, yellow pages, and internet. Perform uploads of provider database information to the searchable provider database portions of intranet/Internet sites including all insurances providers search portals.

REPORTING STRUCTURE

- Send reports to billing operations manager on all matters relating to credentialing follow up and enrollment requirements daily, weekly, monthly.

- Send reports to Ops Manager Billing and Client Practice Manager on all other practice credentialing issues, with insurance and billing.

- Send monthly status reports to Billing CRM for our billing clients.

- Send credentialing detail report including completed accounts, payer client vise status, all open issues/payer and client in process reports, to management monthly.

- Quarterly and monthly review of your team performance and evolution reports to HR and management

- User Audits and quality reports to PM Billing.

Job Specification

- Credentialing

- Fluency in English (both verbal and written) is mandatory.

- Proficient in Microsoft office


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