Offer summary

Qualifications:

Five years of experience in US-based AR follow-up and insurance verification., Familiarity with US medical insurance industry and claims processing requirements., Strong communication and problem-solving skills, with a college degree from a reputed institution., Experience with medical software and understanding of CMS-1500 and UB-04 claim formats..

Key responsabilities:

Complete provider enrollments with Medicare, Medicaid, and private payers.

Perform payer network research and verify provider credentials.

Build quality assurance processes for enrollment submissions and maintain provider-payer data.

Negotiate fee rates and maintain a database of fee schedules for optimal reimbursement.

Job description

ClinicMind, the nation’s leader in multi-specialty Electronic Healthcare Records (EHR) software and Revenue Cycle Management (RCM) services, is looking for a full-time RCM Credentialing and ERA Enrollment SME. If you’re excited to be part of a winning team, ClinicMind is a perfect place to get ahead.

RESPONSIBILITIES

Complete provider enrollments with Medicare / Medicaid and all Private Payers. Set up all ERA and EFT enrollments
Perfect provider experience and achieve the shortest turnaround time
Perform complete payer network research, verify provider’s credentials, and provide accurate timelines and open panel availability
Send clients a complete checklist of all the documents required to file the ERA enrollment applications.
Build Quality Assurance processes for a flawless enrollment submission
Perform appeals for closed panels
Complete out of network enrollments and NPI registrations on the payer’s website for providers who choose or are forced to stay out of network
Follow-up regularly and frequently on enrollment application status until the contract comes through.
Set up and maintain CAQH / PECOS
Maintain all provider-payer data in support of the best reimbursement performance.
Perform payer-provider contract analysis & negotiations. fee rate negotiations for you as well.
Maintain a database of the latest fee schedules for all payers. Study the competition and maintain the list of the best possible rates for all relevant procedures for the optimum reimbursement

QUALIFICATIONS

Five years experience in US-based AR follow-up, Insurance and benefits verification with hands on experience in Credentialing and ERA Enrollment..
Familiar with US medical insurance industry and insurance claims processing requirements
Experience of closely working with various clearing houses and Medical softwares.
Understand CMS-1500 and UB-04 claim formats
Experience in handling Chiropractic and Physical Therapy is an added advantage
Excellent listening, communication, and problem-solving skills
Self-motivated and able to work autonomously
Strong interpersonal and communication skills
College degree in a reputed institution.

MUST HAVE:

High comfort level working on Eastern Time Zone/US Shift - Must be available for practice meetings to discuss progress during East Coast Business Hours
Good internet access at home
Mobile Hotspot
Laptop/Desktop of at least 8 GB

Required profile