Make your next big career move by applying as KMC Solutions’ next CREDENTIALING SPECIALIST
Department: RCM - Philippines
Reports To: Head of RCM
The Credentialing Specialist plays a crucial role in ensuring all providers and clinics are credentialed promptly, maintaining up-to-date documentation, and ensuring all providers are current with licensures.
On top of your salary, here are the exciting benefits you can look forward to:
- Health Insurance/HMO
- Enjoy unlimited MadMax Coffee
- Diverse learning & growth opportunities
- Accessible Cloud HR platform (Sprout)
- Above standard leaves
The main responsibilities of a CREDENTIALING SPECIALIST include:
- Demonstrate quality computer skills and a comprehensive command of essential Microsoft applications, including Outlook, Word, Excel, and Teams.
- Manage the entire insurance credentialing process for vision practices, ensuring compliance with all relevant regulations and guidelines.
- Maintain a comprehensive database of provider information, including licenses, certifications, and insurance documents.
- Verify the accuracy and completeness of all insurance applications and related documents.
- Communicate with insurance companies, payers, and other relevant organizations to resolve credentialing issues.
- Ensure timely submission of credentialing applications and follow up on the status of pending applications.
- Collaborate with vision practices, administrative staff, and external parties to gather necessary information for credentialing.
- Stay updated on industry regulations, changes, and trends related to insurance credentialing.
- Assist in developing and implementing strategies to improve the overall credentialing process.
- Prioritize and maintain strict confidentiality in all situations.
- Manage incoming and outgoing communications between multiple parties, meeting policy timelines, and updating the credentialing database; provide status reports and communicate provider and/or clinician participation information to internal and external customers.
- Possess critical thinking skills and navigate challenges with forethought and common sense to achieve successful outcomes.
To apply, you must be an expert on the following requirements:
- 2-3 years of experience in credentialing within a vision/medical office setting.
- Strong written and verbal English skills.
- Basic understanding of ICD-10 coding preferable.
- Proficiency with Microsoft Office and Adobe.
- Ability to work in a fast-paced environment.
- Attention to detail and ability to multitask effectively.
- Ability to work independently and as part of a team.
- Adheres to internal and system-wide
It will also be favorable if you are knowledgeable in:
This role has been closed
Applications are no longer being accepted for this position.