HealthRecon Connect Logo
  • Full Time
  • India

HealthRecon Connect provides technology-enabled Revenue Cycle Management solutions to US healthcare providers. The company leverages over 30 years of deep domain expertise, machine learning, AI, cutting-edge analytics, and automated workflows that help improve cash flow, patient outcomes and enable peace of mind for their clients. At HealthRecon Connect, day after day, we not only hold ourselves accountable for setting and maintaining high standards, but we also passionately strive for the highest achievement, customer delight and thrive on the challenge of high expectations and commitment to excel.

HealthRecon was certified a Great Workplace by Great Place to Work® Sri Lanka for five consecutive years and was adjudged one of the 40 Best Workplaces in Sri Lanka in 2021. HealthRecon is also a Signatory Participant of the United Nations Global Compact.

We have exciting opportunities for Specialist – Credentialing to join our team. Please review the criteria and other information listed below thoroughly prior to applying and pay specific attention to the work week, shift details and other features of the job. Due to the large volume of applications we receive, all applications will be reviewed in the order in which they were received and only the candidates short-listed for the first round of interviews will be contacted. Thank you for your understanding.

Job Vacancy:
Specialist – Credentialing

Work Week:
Monday to Friday

Other Features:
Full-time
US calendar applicable

Key Responsibilities:

  • Credentialing application submission & follow up to be carried out efficiently according to the daily production targets specified by management.
  • Generate credentialing reports, analyze and work based on priority levels.
  • Download/ verify correspondences related to credentialing function from Box folder/ SFTP/ EHR.
  • Ensure daily credentialing follow ups carried out as expected.
  • Ensure proper analysis being done before reaching out to insurance representatives and resolve internal gaps are identified eliminated.
  • Develop a Credentialing Plan and Root Cause analysis and share with management review.
  • Ensure payer approval rate is achieved as expected for the assigned client/s.
  • Act as the point of contact for assigned client for internal and external queries.
  • Ensure QA reports are reviewed, fixed, and responded back to the QA teams within 24 hours.
  • Ensure to responded back to all internal e-mails within the shift time.
  • Daily and Weekly assigned reports to be shared within the given timelines.
  • Ensure to update SOPs in a timely manner and according to the required level.
  • Conduct random QA on a percentage decided by the management.
  • Perform QA daily if allocated and ensure to share QA reports with the relevant personnel.
  • Credentialing payer follow up and call quality to be maintained at 98% accuracy or greater.
  • Conduct training to newcomers on the job specific functions.
  • Enforce company regulatory standards to ensure the area of responsibility is in compliance with HIPPA and ISO standards.
  • Perform researching and root cause analysis to improve the profitability of the respective client/s.
  • Act as the focal point for knowledge sharing within the team while attend to need basted team member training.
  • Develop Technical Training manuals for the assigned client/s for the reference of new members.

 

Qualifications/Criteria:

  • Three years of experience in RCM Operations and at least one year of experience in credentialing.
  • Partially qualified in any degree/professional qualification
  • Ability to work with MS Office package.
  • RCM Billing Operations knowledge is a plus.
  • Good written and verbal communication skills.
  • Ability to work under pressure.

Let HealthRecon Connect be your partner in success.

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