Credentialing Specialist

1 - 6 years

3 - 6 Lacs

Posted:8 months ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

Skill - Credentialing, Insurance Eligibility, Enrollment

Location - Pune (WFO)

Notice period - Immediate joiners (candidates who can join immediately)

Profile Overview:

  • Graduate with 1-7 years Experience of Credentialing
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
  • Keep track of expiration dates for state DEA licenses, board certifications, and malpractice insurance for individual providers.

Key Responsibilities:

  • Maintain individual provider files with up-to-date information for governmental and commercial payer credentialing applications.
  • Track contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH to ensure all portal logins are active and accessible.
  • Collaborate with providers to ensure timely updates to their CAQH database files as per CMS Medicare/Medicaid and Managed Care Organizations regulations.
  • Coordinate, monitor, and maintain the credentialing, re-credentialing, and contracting processes with insurance companies.

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