Sr. Credentialing Specialists Job Vacancy in Catalytic Solutions Chennai, Tamil Nadu – Latest Jobs in Chennai, Tamil Nadu

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Company Name : Catalytic Solutions
Location : Chennai, Tamil Nadu
Position : Sr. Credentialing Specialists

Job Description : Process Credentialing Specialist_Medical BillingExperience: 3++ years of Healthcare Experience in CredentialingLocation: Chennai / WFHSalary: 35k to 45k+ depending on experienceEmployee Status: Full Time EmployeeShift: UK Shift & US ShiftJob Description: ResponsibilityBusiness / Customer: For Provider ServicesWork on the difficult and complex Credentialing verification with stringent turnaround time and specifics are necessary.Complete missing information in provider details and update the database accordingly for first time providers and already existing provider groups in the client systems or database.Maintain accuracy on data procured during outreach/Fax or Email.Validate and update the information into the client/customer systems to remove duplicate /unwanted /expired information.Review and analysis of the provider application for completeness and accuracy.Verification of data through approved sources listed by the client.Data entry of updated/additional information from provider application to client system after due verification.Collect all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as listed by the client.Make outreaches to providers to collect missing.Data Processes: Efficiently Process predefined number of transactions as assigned with highest level of accuracy as agreed upon by the client.Provide highest level of customer satisfaction.Strive to understand and resolve issues/queries at the first instant.Maintain the business controls as per the requirement.Articulate/ communicate in a manner which is understood by clients / endusers.Connect & provide highest level of satisfaction to the customer.For Member Management: Generate clients pecified reports relating to operations.Respond to data requests and other inquiries related to Credentialing.Provide reports and other data requests specified by the client.Serve as first level contact for customer complaint resolution.Provide reports and other data requests specified by the client.Voice Processes: For RCM, Provider Services And Member ServicesMake and Answer calls to and from customers/end users based on agreed time frames.Transfer calls involving next level of service to the appropriate department as per the given guidelines.Process Excellence – SME: Ensure to meet all Statistical, Financial and TAT metrics while processing Primary Source Verifications.100% Process adherence to transaction processing timelines involving Credentialing processes.Adhere to audit compliance (Internal, Statutory Audit) of all Healthcare processes as laid out by All Care Therapy / the client of All Care Therapy.Ensure process guidelines are followed and met as documented.Set productivity /Quality benchmark.Adhere to shift handover processes.Raise process related issues / concerns on time with process and team leads.Record data relating to production statistics, enduser related notes, etc as appropriate.Stay updated with the process knowledge / changes refer to knowledge updates/ repositories to effectively process transactions.Adhere to security practices set by organization.Implement small process improvement projects.Provide updates and submit reports related to own area of work.Resolve process related queries and expedite on data requests.Respond to data requests.Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.Maintain acceptable levels of performance including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives.Contribute new ideas and innovative approaches at work.Participate in project and organization initiatives led by the Delivery leadership.For Medical Management: Adhere to Utilization Review Accreditation Commission (URAC), jurisdictional, and/or established best practices in Credentialing time frames, as appropriate.Develop a complete understanding of the End to End Credentialing Process.Perform primary source verifications in an accurate, efficient and timely manner while ensuring compliance with utilization management regulations and adherence to state and federalIdentify missing records and information that are necessary in the completion of the medical review assessment.Adhere to Department of Labor, state and company time frame requirements.Track status of all Provider/Group Credentialing in progress and follow up on all pending cases.Work closely with management team in the ongoing development and implementation of utilization management programs.Respond to inbound telephone calls pertaining to Credentialing in a timely manner, following client established protocols.Process customer calls consistent with program specified strategies and customer satisfaction measurements to include but not limited to proper answering procedure, eg opening and closing remarks.Learn new methods and services as the job requires.Advise supervisor of any potential problems as they become evident.Manage assigned workload within established performance standards.Perform quality control on medical review assessments generated by the medical review process.Utilize the approved monitoring tool and updated template completion guidelines as required to compile and track performance of each associate.Provide feedback to the Team Leads and Manager on the performance of each associate and the team as a whole.Maintain and secure confidentiality of Client’s data and all individually identifiable health information accessed through the client’s and/or company systems.Coordinates with the immediate superior regarding updates in policies, procedures and process flow, and state requirements.Learn new protocols and systems as the job requires.Escalate to the immediate superior any unforeseen events or situation beyond assigned tasks and jurisdiction.Cross training on multiple process.Must Have Skills: In depth knowledge on US Provider Credentialing; Healthcare Terminologies and concepts; Strong communication skills.Job Type: Full-timeSalary: ₹35,000.00 – ₹45,000.00 per monthContact EmployerHR Department+91-XXXXXXXXXXJob Types: Full-time, Regular / PermanentSalary: ₹35,000.00 – ₹45,000.00 per monthBenefits:Food allowanceHealth insuranceSchedule:Evening shiftFixed shiftMonday to FridayNight shiftUS shiftSupplemental Pay:Yearly bonusCOVID-19 considerations:YesExperience:provider credentialing: 2 years (Required)Language:English fluently (Required)Shift availability:Night Shift (Required)Overnight Shift (Required)Speak with the employer+91 +91-XXXXXXXXXX

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