7 Ncqa Jobs

As a Credentialing Specialist/Coordinator at InteliX Systems, your role will involve performing Primary Source Verification (PSV) for provider credentials. This includes verifying medical education, residency and fellowship training, state licensure, board certification, work history, and malpractice history. You will be responsible for ensuring compliance with regulatory standards such as NCQA, URAC, JCAHO, and internal policies. This will require you to contact medical schools, licensing boards, hospitals, and other institutions to obtain and validate provider information. Accurate documentation of all communications, verification outcomes, and follow-up actions will be essential. You will...

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 initiati...

We are seeking a dynamic Intelligent Automation (IA/RPA) Project Manager to join our Business Transformation Team. With a relentless focus on driving results for our customers and enhancing their customer care experience, you will play a crucial role in automating customer operations. Proficiency in RPA Projects is a key requirement for this position. As the Project Manager, you will lead end-to-end project management for US healthcare clients, encompassing scoping, budgeting, scheduling, risk, and stakeholder management. Your responsibilities will include coordinating cross-functional teams, ensuring project deliverables meet quality standards, managing communication with stakeholders, iden...

As a Data Analyst with deep experience in the US Healthcare industry and skills around Machine Learning (ML), you will play a vital role in conducting comprehensive data analysis using statistical and exploratory methods to uncover patterns and insights that drive data-driven decision-making in the healthcare domain. Leveraging your knowledge of healthcare industry metrics such as HEDIS, CMS Star Ratings, risk adjustment models, and revenue cycle data, you will optimize analytics strategies to ensure efficient data quality, availability, and reliability for AI/ML-driven healthcare analytics solutions. Your responsibilities will include designing and maintaining data pipelines for the ingesti...

POSITION SUMMARY The Senior MD Analyst is responsible for supporting the development and design of clinical information systems and treatment protocols for the deployment of ZeOmega's Jiva platform. The role is responsible of abstraction, analysis and submission of clinical data. This position will work on the quality and coordination of data collection, entry, analysis, submission, report preparation, presentation of data, data sharing for process improvement initiatives, bench marking and outcomes research. This position communicates the report findings to others throughout the organization, including recommendations for improvements and focused studies. Works in partnership with ZeOmega l...

Overview: As a Credentialing Executive, you will play a crucial role in ensuring that our healthcare organization maintains compliance with regulatory standards and delivers high-quality care by thoroughly vetting and credentialing healthcare providers Your attention to detail, understanding of healthcare regulations, and ability to build strong relationships will be instrumental in facilitating the credentialing process and maintaining accurate provider databases. Responsibilities: Provider Credentialing: Manage the credentialing process for healthcare providers, including physicians, nurse practitioners, physician assistants, and allied health professionals This involves collecting, verify...

Job Title: Team Leader Credentialing Department: US Healthcare Operations Location: Noida Experience Required: 6–10 Years Employment Type: Full-Time Job Summary: We are seeking a dynamic and experienced Team Leader – Credentialing to oversee and manage a credentialing team within the US healthcare domain. The ideal candidate will be responsible for ensuring timely and accurate provider enrollment, re-credentialing, and compliance with payer and regulatory standards. This role demands strong leadership, process optimization, and stakeholder management skills to maintain high levels of quality and client satisfaction. Responsibilities: Lead and supervise daily operations of the credentialing t...