Credentialing Specialist - Karachi, Pakistan
Karachi
Medical Billing /
Full Time /
On-site
About Circadia:
Circadia is a dynamic and rapidly growing health tech startup on a mission to revolutionize healthcare through innovative mobile technology solutions. Our mobile apps empower healthcare professionals and patients alike to make informed decisions, streamline processes, and improve patient outcomes. We are a passionate team of individuals dedicated to making a positive impact in the healthcare industry.
Job Responsibilities
- Manage the entire credentialing process, from initial applications to ongoing maintenance and re-
- Credentialing for healthcare providers.
- Manage and submit enrollment applications to various insurance carriers and government agencies.
- Verify and maintain accurate provider information, including licenses, certifications, and insurance policies.
- Maintain organized records of credentialing documents, expirations, and updates.
- Stay up-to-date with industry regulations and insurance company requirements to ensure providers remain compliant.
- Liaise with insurance companies, healthcare providers, and relevant parties to resolve credentialing issues and inquiries.
- Identify and address any obstacles or challenges in the credentialing process promptly and effectively.
- Work closely with the RCM staff to identify and resolve issues related to provider credentialing.
- Maintain accurate provider profiles on the CAQH, PECOS, NPPES, and CMS databases.
- Maintain an internal provider grid to ensure all information is accurate and logins are available.
- Generate reports and provide insights to support decision-making related to credentialing and provider enrollment.
- All applications should be visible in the Credentialing G_Drive. Follow-up and inquiry calls should be made through company-provided phone lines to keep track of follow-ups.
- Suggest and implement process improvements to enhance efficiency and accuracy in credentialing.
Job Requirements:
- Minimum of 3 years of experience in the relevant field
- Strong knowledge of medical billing and coding practices, as well as healthcare regulations and insurance policies
- Experience in RPM billing preferred
- Bachelor’s Degree – Computer science, Healthcare Administration, or Commerce-related degree preferred
- Proficiency in English Language, Proficiency in GSuite and Slack, Outstanding problem-solving and organizational abilities
- Solid understanding of billing software and electronic medical records
- Exceptional communication and time management skills
- Attention to detail is a must
- Demonstrated ability to work independently
- Knowledge of HIPAA requirements related to medical records and billing requirements
- Ability to manage multiple projects concurrently
KPIs:
- Application Processing Time: The application should be submitted 24-48 hours after the request has been
- made.
- Accuracy of Applications: Applications should be submitted with 95–100% accuracy; applications should rarely be returned for corrections due to date entry errors.
- Application Approval Rate: 95% of applications should be approved on the first submission.
- Timely Follow-Up: You should follow up on any additional documentation/information requests promptly.
- Regular Report: Each entity should receive at least a weekly report summarizing the following: # of applications pending submission, # of applications submitted, # of applications sitting with the payer, # of rejected applications, etc. You should also include all application follow-ups.
Benefits
- Private healthcare insurance (OPD +IPD) with Jubilee Platinum for you and your immediate family (spouse & children)
- Company paid dinner or lunch as per your working shift
- 14 days of annual leave as well as 10 days of casual or sick leave
- Paid professional development training/certifications (If required)
