Credentialing Executive

Job Description

The Credentialing Executive will be responsible for managing the credentialing and re-credentialing processes for psychiatric care providers within our network. The role will also focus on maintaining up-to-date provider documentation, ensuring compliance with insurance companies, and monitoring provider licensing. This position requires a detail-oriented and proactive individual to ensure the smooth integration of providers into the insurance network and their continued compliance. Responsibilities: Assist in the enrollment of providers with insurance companies, ensuring all required documentation is submitted timely and accurately. Collect, verify, and maintain the necessary documentation for all providers, ensuring compliance with regulatory standards and insurance requirements. Proactively follow up with insurance companies to track the status of credentialing applications, resolve issues, and ensure providers are credentialed in a timely manner. Coordinate and manage the re-credentialing process for existing providers, ensuring timely submissions and compliance with insurance companies requirements. Monitor and maintain CAQH (Council for Affordable Quality Healthcare) profiles for all providers, ensuring accuracy and compliance with industry standards. Oversee the process of enrolling providers with Medicare, ensuring compliance with all relevant regulations and ensuring successful enrollment. Requirements: Minimum of 5 years of experience in healthcare credentialing or provider relations, preferably in US healthcare sector. Candidate must have a bachelor s degree in any field. Experience with insurance portals, CAQH, and Medicare enrollment systems Excellent communication and interpersonal skills, with the ability to build rapport and trust at all levels of the organization. In-depth knowledge of credentialing processes, insurance company contracting, and regulatory requirements in the healthcare sector. Strong organizational and time management skills, with the ability to handle multiple tasks and deadlines. Ability to maintain confidentiality and work with sensitive provider data in a HIPAA-compliant manner. Benefits: Competitive salary (including EPF and PS) Health insurance Four days workweek (Monday Thursday) Opportunities for career growth and professional development Additional benefits like food and cab-drop are available