6 Credentialing Software Jobs

The role involves managing the full-cycle credentialing and re-credentialing process for healthcare providers. This includes verifying and maintaining provider documentation, licenses, certifications, and affiliations. Coordination with insurance companies, hospitals, and healthcare organizations for provider enrollment is crucial. Compliance with NCQA, CMS, and other regulatory requirements must be ensured. It is essential to maintain accurate and up-to-date records in credentialing databases. Effective communication with providers regarding application status, missing information, or required updates is necessary. Additionally, supporting audits, reporting, and quality improvement initiatives is part of the responsibilities. The ideal candidate should have a minimum of 1 year of hands-on experience in healthcare credentialing or provider management. Familiarity with credentialing software/systems such as CAQH, NPPES, PECOS, etc., is required. Excellent organizational and documentation skills are essential for this role.,

As a Credentialing professional in Chennai, you will be responsible for collecting, reviewing, and verifying providers" education, training, licensure, certifications, and work history. Your role will involve ensuring compliance with state, federal, and organizational regulations. Additionally, you will be completing and submitting applications for provider enrollment with insurance networks, Medicare, Medicaid, and hospital privileges. It will be your duty to track application status, follow up on pending approvals, and maintain up-to-date provider information in credentialing databases and systems. You will play a crucial role in tracking expiration dates for licenses and certifications to ensure timely renewals. Acting as a liaison between providers, insurance networks, and regulatory agencies will be part of your responsibilities. Effective communication with physicians and healthcare staff regarding credentialing requirements and updates is essential. You will also address and resolve any discrepancies or delays in the credentialing processes and investigate providers" complaints related to credentialing and enrollment. The qualifications and requirements for this role include a minimum of 1 year of experience in credentialing. While a college degree is a plus, it is not mandatory. Preferred skills for this position involve having strong attention to detail and organizational skills, knowledge of credentialing software and databases such as CAQH and PECOS, familiarity with regulatory guidelines like CMS, NCQA, and Joint Commission, ability to work independently, meet deadlines, and effectively communicate with clients and internal billing departments to resolve issues. Your communication skills, especially in English, will play a vital role in this role. You are expected to have the ability to read and communicate effectively in English to carry out your responsibilities efficiently.,

As an Assistant Manager Credentialing, you will report to the Director of Credentialing & Contracting. Your responsibilities include providing regular updates on the team's performance, project progress, milestones, and challenges faced. You will ensure the team aligns with set goals and objectives, addressing any issues promptly and making recommendations for improvement. Your role involves completing, coordinating, and auditing provider applications and credentialing packets. It is essential to maintain up-to-date documentation and ensure compliance with recredentialing and re-enrollment processes to avoid coverage gaps or billing disruptions. You will oversee a team of Team Leads, Credentialing Specialists, Coordinators, and Trainees, creating a supportive work environment, implementing streamlined enrollment processes, and monitoring employee performance. Acting as a liaison between providers and insurance companies, you will troubleshoot application issues and maintain accurate records in credentialing databases. Additionally, you will collaborate with internal departments to ensure timely provider enrollment and credentialing before billing claims. Strong knowledge of US healthcare and insurance requirements, familiarity with credentialing software, organizational skills, leadership qualities, and effective communication are essential for this role. Proficiency in computer applications, including Word and Excel, and the ability to work night shifts are also required. The ideal candidate should hold a Bachelor's or higher degree in a relevant field, with a minimum of 10 years of experience in the US healthcare industry. The position is for night shifts from 6:30 pm to 4:00 am, Monday to Friday, based in Mohali. Salary will be commensurate with experience.,

You will be responsible for managing end-to-end provider enrollment and re-credentialing processes with insurance networks, hospitals, and healthcare facilities. This includes reviewing provider documentation for accuracy, completeness, and compliance before submission and ensuring timely completion of credentialing tasks. Additionally, you will train, mentor, and evaluate team members to maintain quality standards and achieve productivity goals. Your role will also involve generating and analyzing reports on credentialing status, performance metrics, and compliance indicators. Collaborating with internal departments, clients, and third-party entities to optimize credentialing workflows will be a key aspect of your responsibilities. Identifying and implementing process improvements to increase operational efficiency and enhance client satisfaction will also be part of your duties. To excel in this role, you must have a strong expertise in Credentialing, Provider Enrollment, and US Healthcare Regulations. Demonstrated leadership and team management skills are essential for this position. Excellent communication and problem-solving abilities are also required. Proficiency in using credentialing software and reporting tools will be beneficial for effectively carrying out your responsibilities.,

As a Credentialing Analyst at Medusind, you will play a crucial role in managing and maintaining credentialing files for healthcare providers to ensure compliance with regulatory standards and guidelines. Your responsibilities will include data entry, verification of credentials, communication with healthcare organizations and insurance companies, and maintaining accurate records. To excel in this role, you should have experience in credentialing, data entry, and verification processes. Strong organizational skills and attention to detail are essential for successfully managing the credentialing files. Your excellent written and verbal communication skills will be valuable in liaising with providers and keeping the credentialing process on track. Proficiency in using credentialing software and databases is required to handle the day-to-day tasks effectively. You should be able to work independently while also collaborating effectively as part of a team. Knowledge of regulatory standards and guidelines related to credentialing will be beneficial in ensuring compliance. A Bachelor's degree in a related field or relevant experience will be advantageous in performing the duties of a Credentialing Analyst efficiently. If you are looking to join a dynamic team dedicated to maximizing revenue and reducing operating costs in the healthcare industry, this full-time, on-site role in Ahmedabad could be the perfect opportunity for you.,

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.,