ALI MUHAMMAD

Credentialing Specialist

_Remote | Medical Billing & Revenue Cycle_

*Job Summary*

Experienced Credentialing Specialist managing full-cycle provider enrollment and re-credentialing for US healthcare providers. Ensures providers are fully authorized for payment across Commercial, Medicaid, HMO, and Medicare Advantage plans while maintaining strict HIPAA compliance.

Key Responsibilities

- Manage full-cycle credentialing and re-credentialing for multiple insurance panels including Commercial, Medicaid, HMO, and Medicare Advantage plans

- Maintain and update CAQH profiles and Credy App for provider data maintenance, including regular attestations

- Handle Medicare and Medicaid revalidations, Initial Ennrollment contract amendments, and fee schedule updates with Advantage plans and commerical.

- Streamline practice workflows through ERA setup and electronic enrollment.

- Lead provider onboarding and enrollment processes with insurance payers

- Monitor contract amendments to ensure optimal reimbursement rates

- Maintain accuracy of provider documentation and demographic updates

- Coordinate with insurance companies to resolve credentialing inquiries and delays

Technical Skills & Tools

- Platforms: Availity, Echo, Credy App, CAQH, Trizetto, Claims MD, PECOS, NPPES

- Systems: AthenaOne, Kareo/Tebra (Standard & Premium), SmartCloud

- Enrollment: ERAsetup, electronic enrollment portals

Qualifications

- Expertise in US healthcare provider credentialing and enrollment

- Knowledge of Commercial, Medicare Advantage, and Medicaid payer requirements

- HIPAA compliance training

Experience Highlight

Credentialing Specialist at ASA Billing Services LLC (June 2024 – Present)

- Led provider enrollment and re-credentialing for multiple insurance panels

- Managed ERAsetups and monitored contract amendments

• As an experienced Medical Billing Professional with over a year of hands-on experience, I am dedicated to optimizing revenue cycles and ensuring financial health for healthcare organizations. My approach is rooted in a deep sense of responsibility for maximizing collections, minimizing denials, and enhancing patient satisfaction.
  I specialize in:
  • Revenue Optimization & Denial Management: Proven ability to significantly increase successful claim resolutions and recover revenue through proactive denial management and appeals. My strategies directly support increased overall profitability.
  • Efficient Claims & Aging Management: Expertise in claims submission, eligibility, and accounts receivable, consistently reducing aging balances and optimizing cash flow by diligently addressing outstanding balances and securing vital insurance updates from patients for over ten practices.
  • Software Proficiency: Skilled in Tebra/Kareo and Athena one, leveraging these platforms for accurate data entry and streamlined billing operations.
  • Proactive Communication & Problem-Solving: Adept at engaging with patients and facilities to resolve billing inquiries, leading to faster payments and fewer rejected claims. I utilize strong analytical skills to identify root causes of complex billing issues and implement effective solutions.
  Proficient in navigating essential eligibility portals including UHC, CMS, Novitas, Availity, Navinet, and AmeriHealth. I am committed to continuous learning and delivering high-quality results that directly contribute to the success of any healthcare organization.

• Greeted customers, built rapport, and provided excellent customer service.
• Operated the cash register efficiently and accurately.
• Assisted with stock maintenance and inventory control.
• Actively participated in sales efforts, exceeding targets.
• Boosted sales revenue by cultivating strong client relationships and implementing effective sales strategies.