- 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.

- Stay informed about changes in credentialing standards, regulations, and industry best practices, and incorporate updates into credentialing processes and procedures.

- Assist with special projects and initiatives related to provider credentialing and network management as assigned.

- Bachelor's degree in healthcare administration, business administration, or related field preferred.

- Minimum of 4 years of experience in credentialing and provider enrollment, preferably in a healthcare or RCMS setting.

- Strong understanding of credentialing processes, standards, and regulations, including NCQA, URAC, and CMS requirements is preferred.

- 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.

- Certification in healthcare credentialing, such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM), is preferred.

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

Shift : night/ US shift