Provider Credentialing Specialist - PST Time - Night Shift

Interscripts Software

3 - 8 years

1 - 6 Lacs

Hyderabad

Posted:2 weeks ago| Platform:

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Skills Required

Credentialing Provider Data Management provider credentialing

Work Mode

Work from Office

Job Type

Full Time

Job Description

Job Summary

Provider Credentialing Specialist

Key Responsibilities

Collect, verify, and update provider data from various sources (CAQH, state boards, DEA, NPDB, OIG, etc.).
Initiate credentialing and re-credentialing processes according to regulatory and client timelines.
Evaluate credentialing applications for accuracy, completeness, and compliance with credentialing criteria.
Liaise with providers, internal teams, and third-party verifiers for timely document submission and clarifications.
Maintain and audit provider records in credentialing platforms (e.g., Cactus, Echo, HealthLine, Medversant).
Generate and review primary source verifications (PSVs), sanction checks, and background verifications.
Prepare credentialing files for committee review and credentialing decisions.
Track and manage expirables (licenses, certifications, malpractice insurance) and send timely notifications.
Ensure compliance with
HIPAA
,
CMS
,
NCQA
,
URAC
, and other accreditation standards.
Support reporting, audit requests, and data submissions to clients and regulatory bodies.
Collaborate with cross-functional teams (payer enrollment, provider data management, contracting).

Required Qualifications

Bachelor's degree or equivalent experience in healthcare administration, life sciences, or related field.
24 years of hands-on experience in healthcare provider credentialing (preferably BPO/KPO setup).
Working knowledge of NCQA, URAC, and CMS credentialing standards.
Familiarity with credentialing software tools (Cactus, Echo, CACTUS/Symplr, Medversant).
Excellent attention to detail, time management, and organizational skills.
Strong written and verbal communication skills for provider and client interactions.
Proficiency in MS Excel, Outlook, and document management systems.
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