Credentialing Specialist

Credentialing Specialist:

● Maintain compliance with all regulatory and accrediting institutions

● Design and maintain the development and enhancement of internal credentialing and managed care contracting processes.

● Release information to agencies and members of the public as required by law

● Monitoring and ensuring credentials documents are maintained and current.

● Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch.

● Coordinate data between internal and external systems, including licensures, CAQH, and NPPES.

● Proactively identify and resolve issues, coordinate resolutions, and identify educational opportunities.

● Maintain expertise in industry regulations (NCQA, URAC, State, Federal/CMS) and serve as the organization's regulatory subject matter expert.

● Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

● Maintains confidentiality of provider information.

● Provides enrollment with government and commercial payers.

● Monitoring and ensuring credentials documents are maintained and current.

● Data entry and follow up in credentialing software.

● Use payer credentialing systems and manage payer contracts.

● Release information to agencies and members of the public as required by law.

● Maintain a contract repository with rate sheets for revenue cycle staff.

● Develop and negotiate managed care contracts with payers.

● Monitor contract performance and compliance.

● Analyze financial and operational impact of contracts.

● Maintain relationships with managed care organizations.

● Ensure contracts align with organizational goals and regulatory requirements

● AR Calling and denial work as assigned

● Other duties as assigned.

Other Responsibilities:

● Displays a competent knowledge of CMS and insurance policy and procedures as well as Federal and State Regulations. Keeps current with available resources.

● Maintains confidentiality, proper boundaries and an ethical relationship with clients and co-workers accordingly to Company's policies.

● Ensures all provider records are maintained according to agency standards, policies and procedures.

● Completes annual educational program as required.

● Participates in the development of quality improvement activities designed to enhance agency and program services

● Performs Other Duties as Needed

Job Types: Full-time, Permanent

Pay: ₹40,000.00 - ₹48,000.00 per month

Benefits:

• Health insurance
• Leave encashment
• Life insurance
• Provident Fund

Application Question(s):

• How many years of experience do you have as a Credentialing Specialist?
• What is your current salary and your expected Salary?
• Are you an immediate joiner? Please mention your notice period?

Work Location: In person