Company Overview

Total RCM Solutions is a leading revenue cycle management company serving healthcare providers in the US. With a focus on tailored processes, robust expertise, and comprehensive support services, we deliver innovative medical billing and back-office solutions, backed by a team with over 100 years of industry experience. Learn more at totalrcmsolutions.com.

Job Overview

This Insurance Credentialing Specialist position is a full-time, hybrid opportunity for mid-level professionals with 4 to 6 years of relevant experience. The role is based in Bengaluru or Chennai and involves ensuring providers are properly credentialed with government and commercial payers. You will work with a dynamic team focused on delivering high-quality credentialing and related support to healthcare clients.

Qualifications and Skills

• Proven experience of at least four years in insurance credentialing, including hands-on credentialing activities for multiple healthcare providers.
• Expertise in end-to-end credentialing processes, including initial enrollment, re-credentialing, and updates for health insurance networks (Mandatory skill).
• Strong working knowledge of CAQH, including profile management, data updates, and attestation requirements for provider organizations (Mandatory skill).
• Demonstrated experience with PECOS for managing Medicare enrollment and ensuring compliance with federal regulations (Mandatory skill).
• High reliability and attention to detail, ensuring that all documents and provider information are accurately maintained for credentialing audits.
• Experience in provider enrollment processes with various payers and understanding their specific requirements and compliance guidelines.
• Proficiency in insurance verification processes and ability to troubleshoot issues with credentialing applications in a timely manner.
• Excellent communication and collaboration skills, allowing efficient coordination among healthcare providers, payers, and internal teams.

Roles and Responsibilities

• Complete end-to-end credentialing and re-credentialing for providers across commercial and government health plans.
• Manage and update provider profiles in CAQH and PECOS, ensuring accuracy and compliance with current regulations and payer requirements.
• Liaise with healthcare providers and insurance agencies to obtain, submit, and track required credentialing documentation.
• Verify provider credentials and ensure all certifications and licenses are current as part of insurance verification and enrollment processes.
• Monitor and troubleshoot credentialing status, resolving data discrepancies and tracking pending applications diligently.
• Maintain up-to-date records and generate periodic credentialing status reports for internal teams and client review.
• Work collaboratively with RCM and support teams to ensure seamless integration of credentialing data with billing operations.
• Stay abreast of industry changes in payer requirements, compliance standards, and best practices related to credentialing and enrollment.