Provider Enrollment and Credentialing process of the group practices and individual providers (New and Existing)

Handling Provider Enrollment and Credentialing process of the group practices and individual providers (New and Existing)Submitting credentialing, re-credentialing and revalidation applications of the providers and the group practices to the respective payers.Communicating with onshore team on obtaining all the required information to onboard the new provider(s).Working on PECOS, NPPES and CMS I&A portals to update the providers information on regular basis.Applying for NPI… Show more Handling Provider Enrollment and Credentialing process of the group practices and individual providers (New and Existing)Submitting credentialing, re-credentialing and revalidation applications of the providers and the group practices to the respective payers.Communicating with onshore team on obtaining all the required information to onboard the new provider(s).Working on PECOS, NPPES and CMS I&A portals to update the providers information on regular basis.Applying for NPI numbers for the new providers and for the new practice locations that are being added to the group.Working on PAVE (California Medi-Cal) to submit the applications for individual providers (new and existing) and for the group practices.Obtaining renewed copies of State License, DEA, Malpractice (PLI), specialty certificates, Fluoroscopy certificates and uploading into providers' CAQH accounts and completing the re-attestations.Being as the First point of contact with the clients on daily communication on resolving the queries and escalations.Assisting the front office staff, clinic managers and the providers on pending applications related to Enrollment and Credentialing.Validating payer directories including Anthem Blue Cross, Availity, Blue Shield, United Healthcare, etc on quarterly basis and attesting the provider directory data.Involved in Employee Management, Hiring and Training programs, process improvement plans and participating in other innovative discussions with the Management. Show less

Managing complete AR Operations and Denial Management of all the clients across the board.Identifying major denials based on Provider Specialties, Credentialing, Contracting and communicating with the Practice Managers and working towards resolving the denials.Working on daily, weekly and monthly reports and presenting the status of the AR with the respective Practice Managers in US Office.Doing Root cause analysis on rejections and working with clearing houses and payers to resolve… Show more Managing complete AR Operations and Denial Management of all the clients across the board.Identifying major denials based on Provider Specialties, Credentialing, Contracting and communicating with the Practice Managers and working towards resolving the denials.Working on daily, weekly and monthly reports and presenting the status of the AR with the respective Practice Managers in US Office.Doing Root cause analysis on rejections and working with clearing houses and payers to resolve the same and giving feedback / instructions to the billing team.Handling Credentialing and Enrollment process of all the groups and providers.Submitting credentialing, re-credentialing and revalidation applications of the providers and the groups to the respective payers. Updating provider profiles and doing re-attestations in CAQH portals of the respective providers. Show less

US Healthcare Provider Services.Job Functions and Responsibilities:Managing complete AR Operations of all the clients across the board. Providing assistance and directions to the AR and Denial Management teams in identifying and resolving the major recurring denials by doing the RCA (Root Cause Analysis) and fixing the same with the help of respective departments.Communicating effectively on major roadblocks and billing issues with internal departments such as billing… Show more US Healthcare Provider Services.Job Functions and Responsibilities:Managing complete AR Operations of all the clients across the board. Providing assistance and directions to the AR and Denial Management teams in identifying and resolving the major recurring denials by doing the RCA (Root Cause Analysis) and fixing the same with the help of respective departments.Communicating effectively on major roadblocks and billing issues with internal departments such as billing, coding, implementation and credentialing.Working on Weekly and Monthly reports and identifying the underpaid and / or non-payable procedures billed under respective providers and the practices based on the specialties. Coordinating with billing and coding teams on such procedures and finding a resolution with a replacement codes and communicating the same wih the respective clients.Participating in weekly and monthly meetings with the clients and higher management over the phone to discuss the health of the projects in terms of billing, collections, roadblocks and any other escalations.Being as first point of contact with the clients on daily communications on resolving the queries on daily billing, denials and credentialing issues. Show less

Involved in Employee Management, Hiring and Training programs, process improvement plans and participated in other innovative discussions with the Management.Assisting providers in their MUs (Meaning Use) Registration & Attestations, applying for EHR Incentive Programs with CMS by adopting, implementing, or upgrading certified EHR Technology in their practices.Monitoring charges versus payments on weekly and monthly basis of every provider and practice and sharing the reports with the… Show more Involved in Employee Management, Hiring and Training programs, process improvement plans and participated in other innovative discussions with the Management.Assisting providers in their MUs (Meaning Use) Registration & Attestations, applying for EHR Incentive Programs with CMS by adopting, implementing, or upgrading certified EHR Technology in their practices.Monitoring charges versus payments on weekly and monthly basis of every provider and practice and sharing the reports with the higher management and the clients.Working closely with clearing houses, EHR and PMS companies on Rejections, EDI/ERA set ups and data integration.Involving in Interview panel and being a part of hiring the new talents. Conducting briefing sessions with AR Leads and SMEs to discuss on major denials, roadblocks, follow-up procedures, prioritizing and allocation of the AR. Show less

US Healthcare RCMS Provider Services.Job Functions and Responsibilities:Working on Provider credentials, identifying the denial trends by carrier wise and rectifying the provider issues with the respective carriers. Participating in Client Calls and Conferences, Direct Communication with the Clients through emails and phone calls, Maintaining and sharing Week and Month end reports by Insurance wise and provider wise. Analyzing the accounts while taking a global action… Show more US Healthcare RCMS Provider Services.Job Functions and Responsibilities:Working on Provider credentials, identifying the denial trends by carrier wise and rectifying the provider issues with the respective carriers. Participating in Client Calls and Conferences, Direct Communication with the Clients through emails and phone calls, Maintaining and sharing Week and Month end reports by Insurance wise and provider wise. Analyzing the accounts while taking a global action. Rectifying the Major recurring denials. Assigning daily work order and doing QC simultaneously, assigning the re-work to the team by explaining the errors, and Monitoring the Team and resolving the issues to create a work friendly environment. Show less

Handling Claims related to Workers Compensation, No Fault (Auto Injury Claims), Federal and Commercial Insurance Companies. Following up with Employers, Attorneys to get the Insurance details of the patients and submitting the claims to the respective carriers, Follow-up with Workers Comp Board, MVIAC on regular basis to know the status of the cases, reviewing the collections and identifying the under payments and working on the same to get the expected reimbursements from the respective… Show more Handling Claims related to Workers Compensation, No Fault (Auto Injury Claims), Federal and Commercial Insurance Companies. Following up with Employers, Attorneys to get the Insurance details of the patients and submitting the claims to the respective carriers, Follow-up with Workers Comp Board, MVIAC on regular basis to know the status of the cases, reviewing the collections and identifying the under payments and working on the same to get the expected reimbursements from the respective carriers and get the accounts resolved. Show less

Software Used: NextGen EPM (version: 5.5)Worked on Denials and Accunt Receivables with a target to reduce the AR Days and increase the revenue of the providers by accurate follow-up with Insurance Carriers and Patients to get the claims paid in full for the services rendered.

Software used: IDXWorking on outstanding AR to get the status and suggesting the actions. Resolved Claims pending issue with Tricare, DEERS by identifying the policy types. Escalating the denials to the respective departments, worked on Provider Credentials like updation of NPIs in NPPES and with the respective Insurance Carriers.