Credentialing Specialist
5 days ago
- Credentialing SpecialistExperience
- 1 to 2 YearsLocation
- Erode, Coimbatore
Job Description:
The Credentialing and Contract Specialist is responsible for managing the credentialing process for healthcare providers, ensuring compliance with regulatory and accreditation standards and maintaining accurate and up-to-date provider information. This role also involves handling contract management, including the preparation, review and maintenance of contracts with providers, payers, and other entities.
Key Responsibilities:
Credentialing:Oversee the entire credentialing process for new and existing providers.Ensure all provider credentials are verified and maintained according to organizational policies and procedures.Coordinate with providers to obtain necessary documentation and information.Monitor and track credentialing applications, ensuring timely processing and renewals.Maintain accurate credentialing records in the credentialing database/system.Ensure compliance with state, federal and accrediting body requirements.
2.Contract Management:Prepare, review and manage contracts with providers, payers and other healthcare entities.Ensure contracts are compliant with organizational standards and regulatory requirements.Track contract terms, renewals and expirations.Collaborate with legal, compliance and finance departments to resolve contract issues.Maintain a comprehensive contract database and ensure all contracts are up-to-date.
3.Compliance:Stay informed about changes in regulations and accreditation standards related to credentialing and contracting.Conduct periodic audits of credentialing and contract records to ensure compliance.Assist in developing and updating policies and procedures related to credentialing and contracting.
4.Communication and Collaboration:Serve as a liaison between providers, payers and internal departments regarding credentialing and contract issues.Provide training and support to providers and staff on credentialing and contracting processes.Address and resolve provider inquiries and concerns in a timely manner.
5.Reporting:Generate regular reports on the status of credentialing and contracting activities.Present findings and recommendations to management as needed.Track and report key performance indicators (KPIs) related to credentialing and contracting processes.
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