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Cognizant
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SPE-Provider Credentialing

SPE-Provider Credentialing

Cognizant

4 - 6 years

3 - 5 Lacs

hyderabad

Posted:11 hours ago| Platform:

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Skills Required

process providing analytical hipaa us healthcare claims adjudication healthcare bpo healthcare claims processing payment posting re ar calling charge entry denial management credentialing procedures medical billing rcm revenue cycle management communication skills

Work Mode

Work from Office

Job Type

Full Time

Job Description

Job Summary

Join our dynamic team as a Specialist in Provider Credentialing where you will leverage your expertise in healthcare products and credentialing processes to ensure compliance and efficiency. With 4 to 6 years of experience you will play a crucial role in maintaining the integrity of our provider network. This hybrid role offers the flexibility of night shifts allowing you to balance work and personal commitments effectively.

Responsibilities

Oversee the credentialing and re-credentialing processes for healthcare providers to ensure compliance with industry standards and regulations.

Collaborate with cross-functional teams to streamline credentialing workflows and improve operational efficiency.

Analyze provider data to identify discrepancies and implement corrective actions to maintain data accuracy.

Develop and maintain comprehensive documentation of credentialing procedures and policies.

Provide support and guidance to providers throughout the credentialing process to ensure a smooth and efficient experience.

Monitor and report on credentialing metrics to identify trends and areas for improvement.

Implement best practices in credentialing to enhance the quality and reliability of provider information.

Coordinate with external agencies and stakeholders to facilitate timely credentialing approvals.

Utilize healthcare product knowledge to optimize credentialing processes and ensure alignment with organizational goals.

Conduct regular audits of credentialing files to ensure compliance with internal and external standards.

Assist in the development and delivery of training programs for new team members on credentialing procedures.

Participate in continuous improvement initiatives to enhance the overall effectiveness of the credentialing department.

Ensure all credentialing activities are conducted in accordance with company policies and regulatory requirements.

Qualifications

Possess a strong understanding of healthcare products and their application in credentialing processes.

Demonstrate expertise in credentialing and re-credentialing within the healthcare domain.

Exhibit excellent analytical skills to assess provider data and identify discrepancies.

Show proficiency in developing and maintaining documentation of credentialing procedures.

Display strong communication skills to support providers and collaborate with cross-functional teams.

Have experience in monitoring and reporting on credentialing metrics.

Be adept at coordinating with external agencies for credentialing approvals.

Certifications Required

Certified Provider Credentialing Specialist (CPCS)

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SPE-Provider Credentialing