01Overview
ClinicMind, the nations 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 youre 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 providers credentials, and provide accurate timelines and open panel availability
- Build Quality Assurance processes for a flawless enrollment submission
- Perform appeals for closed panels
- Complete out of network enrollments and NPI registrations on the payers website for providers who choose or are forced to stay out of network
- 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 advantages verification with hands on experience in 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 worki .
