Credentialing Specialist I
Description
Responsibilities:
- Coordinate and manage the credentialing and re-credentialing process for healthcare providers, including physicians, nurses, therapists, and other allied health professionals.
- Collect and review provider credentialing applications, ensuring accuracy and completeness of information.
- Verify provider credentials, including education, training, licensure, certifications, and professional experience, through primary sources and credentialing databases.
- Communicate with healthcare providers, licensing boards, professional organizations, and insurance carriers to obtain necessary documentation and resolve credentialing issues.
- Maintain accurate and up-to-date provider credentialing files and databases, ensuring compliance with regulatory standards and accreditation requirements.
- Monitor and track credentialing status and expirations, initiating re-credentialing processes as needed to maintain provider network participation.
- Collaborate with internal departments, including billing, compliance, and human resources, to ensure timely credentialing and enrollment of providers.
Qualifications:
- Bachelor's degree in healthcare administration, business administration, or related field preferred.
- Minimum of 0-2 years of experience in credentialing and provider enrollment, preferably in a healthcare or RCMS setting.
- Proficiency in credentialing software and databases, such as CAQH, NPPES, and payer-specific enrollment portals is a plus.
- Excellent organizational skills and attention to detail, with the ability to manage multiple priorities and meet deadlines in a fast-paced environment.
- Effective communication and interpersonal skills, with the ability to collaborate with internal and external stakeholders.
- Knowledge of medical terminology, healthcare billing, and reimbursement processes is a plus.
If you are a motivated professional with experience in credentialing and provider enrollment, we invite you to apply for the Credentialing Specialist position and join our dynamic team in the RCMS industry.
Location:-Vadodara, Gujarat (work from office only)
Timings:-Night Shift.