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HEALTHCARE CREDENTIALING SPECIALIST

HEALTHCARE CREDENTIALING SPECIALIST

Skillra Technologies

1 - 5 years

0 Lacs

chennai tamil nadu

Posted:1 week ago| Platform: Shine logo

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Skills Required

hospitals compliance cms reporting quality improvement healthcare credentialing provider documentation licenses certifications affiliations insurance companies healthcare organizations ncqa credentialing databases audits credentialing software caqh nppes pecos organizational skills documentation skills

Work Mode

On-site

Job Type

Full Time

Job Description

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.,

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HEALTHCARE CREDENTIALING SPECIALIST