AMS Solutions

• Diseñar e implementar integraciones entre aplicaciones y sistemas con APIs de modelos de lenguaje • Diseñar soluciones utilizando técnicas como RAG, Function Calling, Prompt Engineering • Gestionar el ciclo completo de los datos que alimentan el RAG • Colaborar en múltiples proyectos de desarrollo • Identificar y resolver incidencias técnicas • Mantenerse actualizado respecto a tendencias y tecnologías en integración de LLMs • Documentar procesos y desarrollos

Role Description We are seeking an experienced Medical Credentialing Specialist to help support our team with the end-to-end credentialing and re-credentialing process for healthcare providers across multiple U.S. states. This role is critical to ensuring our clients' providers are properly enrolled with insurance payers, enabling timely and accurate reimbursement. The ideal candidate has strong CAQH management experience and a proven track record in multi-state payer enrollment. Key Responsibilities - Manage initial credentialing and re-credentialing applications for physicians and mid-level providers across multiple U.S. states - Complete and maintain CAQH ProView profiles, ensuring all provider data is accurate, current, and attestation-ready - Submit and track payer enrollment applications with commercial insurance companies, Medicare, and Medicaid programs - Monitor credentialing timelines, follow up on pending applications, and escalate delays to ensure providers are enrolled before their start dates - Maintain organized credentialing files including licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation - Coordinate with providers and practice managers to collect and verify required documentation - Track and manage license and certification expiration dates, initiating renewals proactively - Research and resolve payer enrollment issues, denials, and discrepancies - Stay current on payer-specific enrollment requirements, state regulations, and CMS guidelines - Prepare and submit roster adds/changes for group enrollments - Generate regular status reports on credentialing activities and turnaround times Qualifications - 2-5 years of hands-on medical credentialing and payer enrollment experience - Strong working knowledge of CAQH ProView, PECOS, and NPPES/NPI systems - Demonstrated experience with multi-state credentialing (enrollment across 3+ U.S. states) - Familiarity with commercial payer enrollment processes (UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, Humana, etc.) - Experience with Medicare and Medicaid enrollment procedures - Proficiency in credentialing software and practice management systems - Excellent attention to detail and organizational skills - Strong written and verbal English communication skills - Ability to manage multiple provider files and deadlines simultaneously - Reliable internet connection and dedicated home office setup for remote work Preferred Qualifications - Experience working with U.S.-based medical billing or RCM companies - Knowledge of provider contracting and fee schedule negotiation basics - CPCS (Certified Provider Credentialing Specialist) or CPMSM certification - Experience with EHR/PM systems such as eClinicalWorks, Athena, or AdvancedMD - Familiarity with hospital privileging processes

• Diseñar e implementar integraciones entre aplicaciones y sistemas con APIs de modelos de lenguaje (LLMs). • Diseñar soluciones utilizando técnicas como: RAG, Function Calling, Prompt Engineering, Embeddings y Búsqueda Semántica, Fine-Tuning y Transfer Learning, Chain-of Thought Prompting, y RLHF. • Gestionar el ciclo completo de los datos que alimentan el RAG, cubriendo procesos de generación, extracción, calidad y gobernanza. • Colaborar en múltiples proyectos de desarrollo, apoyando en la integración entre aplicaciones, sistemas, datos y LLMs. • Participar activamente en reuniones y sesiones de brainstorming para proponer mejoras e innovaciones en aplicaciones y procesos. • Identificar y resolver incidencias técnicas, garantizando altos estándares de calidad y escalabilidad en las soluciones implementadas. • Mantenerse actualizado respecto a tendencias y tecnologías en integración de LLMs. • Documentar procesos y desarrollos para facilitar la transferencia de conocimiento al equipo.

• Plantear ideas para mejoras técnicas y funcionales del producto • Diseñar e implementar los componentes necesarios para cada nueva funcionalidad • Velar en el desarrollo por la calidad y limpieza del código • Participar en un entorno SCRUM, con refinamientos y planificaciones estructuradas • Colaboración con equipos multidisciplinares