Senior Credentialing Specialist SGH Management India Pvt Ltd

3.0 - 7.0 years

0 Lacs

punjab

On-site

As a Credentialing Specialist at our company, your primary responsibility will be to manage all provider credentialing activities efficiently. This includes collecting, verifying, and maintaining essential provider information such as licenses, certifications, and work history. You will also be responsible for submitting credentialing applications to insurance companies and credentialing bodies. In addition to provider credentialing, you will be tasked with tracking and completing re-credentialing and re-enrollment processes before expiration dates. Data management is a crucial aspect of this role, where you will update credentialing databases and ensure that all documents are current and accurate. Compliance with industry standards is paramount in this position. You will need to ensure that all credentialing activities adhere to regulations set forth by NCQA, CMS, and JCAHO. Furthermore, you will be responsible for preparing for and supporting internal and external audits to maintain compliance. Effective communication and coordination are essential skills for this role. You will act as a liaison between providers, insurance companies, and billing teams to facilitate smooth operations and resolve any issues that may arise. To excel in this role, you should have a solid understanding of revenue cycle management processes and healthcare insurance systems. Attention to detail and strong organizational skills are crucial for success. Proficiency in using EMR/EHR systems and credentialing software, such as Modio and Verity, is preferred. A good grasp of HIPAA regulations and credentialing compliance standards is also required. This is a full-time and permanent position that involves working night shifts in person at our designated work location. As part of our benefits package, we offer Provident Fund contributions. If you meet the requirements and are interested in this opportunity, please share your resume with us at ssangar@scale-healthcare.in.,

Posted 3 days ago

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