Credentialing Supervisor Vadodara, India

1 week ago

Vadodara, Gujarat, India Qualifacts Systems Inc Full time
Description

  • Coordinate and manage the credentialing and recredentialing process for healthcare providers, including physicians, nurses, therapists, and other allied health professionals.
  • Collect and review provider credentialing applications, ensuring accuracy and completeness of information.
  • Verify provider credentials, including education, training, licensure, certifications, and professional experience, through primary sources and credentialing databases.
  • Communicate with healthcare providers, licensing boards, professional organizations, and insurance carriers to obtain necessary documentation and resolve credentialing issues.
  • Maintain accurate and uptodate provider credentialing files and databases, ensuring compliance with regulatory standards and accreditation requirements.
  • Monitor and track credentialing status and expirations, initiating recredentialing processes as needed to maintain provider network participation.
  • Collaborate with internal departments, including billing, compliance, and human resources, to ensure timely credentialing and enrollment of providers.
  • Stay informed about changes in credentialing standards, regulations, and industry best practices, and incorporate updates into credentialing processes and procedures.
  • Assist with special projects and initiatives related to provider credentialing and network management as assigned.
Qualifications:
  • Bachelor's degree in healthcare administration, business administration, or related field preferred.
- Minimum of 4 years of experience in credentialing and provider enrollment, preferably in a healthcare or RCMS setting.
  • Strong understanding of credentialing processes, standards, and regulations, including NCQA, URAC, and CMS requirements is preferred.
  • Proficiency in credentialing software and databases, such as CAQH, NPPES , and payer specific enrollment portals is a plus.
  • Excellent organizational skills and attention to detail, with the ability to manage multiple priorities and meet deadlines in a fast paced environment.
  • Effective communication and interpersonal skills, with the ability to collaborate with internal and external stakeholders.
  • Knowledge of medical terminology, healthcare billing, and reimbursement processes is a plus.
  • Certification in healthcare credentialing, such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM), is preferred.

If you are a motivated professional with experience in credentialing and provider enrollment, we invite you to apply for the Credentialing Specialist position and join our dynamic team in the RCMS industry.


Location:
Vadodara (Gujarat) work from officeShift : night/ US shift

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