Medical Billing Insurance credentialing

About the Role

Prakruti Medsol LLP is a healthcare-focused organization specializing in medical billing and insurance-related services for clinics and hospitals. This is a full-time, on-site role based in Ahmedabad for a Medical Billing Insurance Credentialing professional.

Key Responsibilities

• Handle insurance credentialing processes for healthcare providers.
• Prepare, submit, and track applications with various insurance carriers and Medicare.
• Review and update provider information.
• Verify credentials.
• Maintain accurate records.
• Ensure compliance with payer and regulatory requirements.
• Work with medical billing teams to address denials, clarify coverage issues, and support timely reimbursements.
• Collaborate with internal stakeholders and external insurance representatives.
• Communicate clearly with providers.

Requirements & Tech Stack

• Strong understanding of Medical Terminology.
• Ability to interpret clinical documentation accurately.
• Knowledge of Denials management.
• Working familiarity with ICD-10 coding principles relevant to billing and insurance claims.
• Experience with Insurance processes, including commercial payers.
• Foundational knowledge of Medicare guidelines.
• Proficiency in using medical billing or practice management software and standard office applications.
• Effective written and verbal communication skills.
• Ability to coordinate with providers, payers, and internal teams.

Qualifications

• Attention to detail.
• Strong organizational skills.
• Ability to manage multiple credentialing files simultaneously.
• Prior experience in medical billing, insurance credentialing, or healthcare administration preferred.
• Relevant diploma or degree in healthcare administration, billing, or a related field is beneficial.