Credentialing Manager

A Credentialing Manager is primarily responsible for overseeing and managing the process by which healthcare providers are verified and approved to deliver care within healthcare organizations, insurance networks, or medical facilities. Their role ensures compliance with regulatory standards, accreditation requirements, and internal policies. Here’s a detailed breakdown of typical roles and responsibilities:

1. Credentialing and Provider Verification

Verify the qualifications, licenses, certifications, and credentials of healthcare providers (doctors, nurses, allied health professionals).

Ensure compliance with state, federal, and payer-specific regulations.

Maintain accurate and up-to-date credentialing records.

Perform primary source verification of education, training, licensure, and work history.

2. Compliance and Regulatory Oversight

Ensure compliance with accrediting bodies such as NCQA (National Committee for Quality Assurance), URAC, The Joint Commission, or state regulatory agencies.

Maintain knowledge of current laws, regulations, and industry standards related to provider credentialing.

Prepare for and facilitate audits or inspections by external regulatory agencies.

3. Credentialing Process Management

Manage the end-to-end credentialing process, from provider application to approval.

Track expiration dates for licenses, certifications, and insurance coverage.

Oversee re-credentialing processes (usually every 2–3 years, depending on organization policies).

Handle credentialing for new hires, network providers, or contracted professionals.

4. Communication and Coordination

Serve as the primary point of contact for providers, staff, and external entities regarding credentialing.

Coordinate with HR, compliance, legal, and payer departments.

Respond to provider inquiries and resolve credentialing issues or delays.

5. Data Management and Reporting

Maintain credentialing databases and electronic filing systems.

Generate reports on credentialing status, compliance, and upcoming renewals.

Monitor key performance indicators (KPIs) related to credentialing efficiency and accuracy.

6. Staff Supervision and Training (if applicable)

Supervise credentialing specialists or assistants.

Develop training programs for new staff on credentialing procedures and standards.

Ensure team members follow consistent processes and meet deadlines.

7. Quality Improvement

Continuously review and improve credentialing processes.

Implement best practices to reduce errors and ensure timely provider approvals.

Stay informed of emerging trends, technologies, and tools in credentialing.

Skills & Qualifications Usually Required:

Knowledge of healthcare regulations, licensing, and accreditation standards.

Attention to detail and strong organizational skills.

Proficiency in credentialing software (e.g., CAQH ProView, symplr, Credentialing Hub).

Strong communication, negotiation, and problem-solving abilities.

Experience in healthcare administration or medical staff services.

Job Type: Full-time

Pay: From ₹50,000.00 per month

Benefits:

• Food provided
• Health insurance
• Provident Fund

Ability to commute/relocate:

• Chennai District, Tamil Nadu: Reliably commute or planning to relocate before starting work (Preferred)

Education:

• Bachelor's (Preferred)