Hamza Ali

Credentialing and Enrollment Specialist

CareCloud • Tiempo completo

Dec 2019 - Feb 2023 • 3 yrs 2 mos

Worked as a Credentialing and Provider Enrollment Specialist at CareCloud, handling complete provider onboarding and credentialing for U.S.-based healthcare providers. My work focused on making sure providers get enrolled with insurance payers smoothly, without delays, and stay active in their networks. I handled full credentialing and re-credentialing processes for individual providers and group practices across different specialties including primary care, internal medicine, behavioral health, cardiology, and DME suppliers. My daily work included managing enrollment and follow-ups with major insurance payers such as Medicare, Medicaid (state programs), Blue Cross Blue Shield plans (Anthem, Highmark, Horizon, Florida Blue), Aetna, Cigna, UnitedHealthcare, Humana, Molina Healthcare, WellCare, and Tricare. I ensured applications were submitted correctly, tracked closely, and completed within required timelines so providers could start billing without interruption. I worked directly on CAQH profile creation, updates, and attestation, along with NPI/NPPES registration and corrections. I also managed PECOS enrollment (CMS-855I, CMS-855B, CMS-855A forms), EFT/ERA setup, payer portal registrations, and roster submissions for group practices. My responsibilities also included verifying all required documents such as licenses, DEA certificates, malpractice insurance, board certifications, W-9 forms, and making sure everything met payer requirements before submission. I regularly performed primary source verification and ensured data accuracy across all applications. Along with enrollment work, I supported provider onboarding by updating demographics, selecting correct taxonomy codes, preparing contracts, sending applications to payers, and following up continuously until approval. I also handled rejections, missing documents, and corrected errors that could delay credentialing. I stayed in direct communication with payer representatives when needed to check application