US Healthcare Credentialing specialist

Job Summary: As a US Healthcare Credentialing Specialist working the night shift in Mohali, you will be responsible for managing the credentialing process for healthcare providers, ensuring compliance with regulatory standards and payer requirements. Your primary objective will be to facilitate the enrollment and credentialing of providers with insurance networks and government agencies, enabling them to deliver healthcare services effectively. This role demands meticulous attention to detail, strong organizational skills, and the ability to work efficiently during night hours to align with US time zones.

Key Responsibilities:

• Provider Credentialing: Manage the credentialing process for healthcare providers, including physicians, nurses, therapists, and other allied health professionals, ensuring accurate and timely completion of credentialing applications and related documentation.
• Credentialing Verification Organization (CVO) Liaison: Serve as a liaison between the organization and Credentialing Verification Organizations, ensuring the timely submission and verification of provider credentials, licenses, certifications, and other required documentation.
• Payer Enrollment: Facilitate the enrollment of providers with various insurance networks, Medicare, and Medicaid programs, adhering to payer-specific requirements and timelines to ensure uninterrupted reimbursement for services rendered.
• Provider Database Maintenance: Maintain up-to-date provider information in credentialing databases and software systems, ensuring accuracy and completeness of provider profiles, credentials, and contract details.
• Compliance Monitoring: Monitor compliance with regulatory standards, accreditation requirements, and payer guidelines related to provider credentialing and enrollment, identifying and addressing any discrepancies or issues promptly.
• Credentialing Audits and Reviews: Conduct periodic audits and reviews of credentialing files and documentation to ensure compliance with internal policies, external regulations, and industry best practices.
• Credentialing Committee Support: Provide administrative support to credentialing committees, including scheduling meetings, preparing agenda materials, recording meeting minutes, and facilitating the review and approval of provider applications.
• Communication and Follow-Up: Communicate regularly with healthcare providers, internal stakeholders, and external agencies to provide updates on credentialing status, resolve issues, and address inquiries in a timely and professional manner.
• Quality Assurance: Ensure the quality and integrity of credentialing processes and data, implementing quality assurance measures and continuous improvement initiatives to enhance efficiency and accuracy.
• Night Shift Availability: Be available to work during night hours to accommodate communication with US-based stakeholders, including providers, payers, and credentialing organizations.

Requirements:

• Bachelor's degree in healthcare administration, business management, or a related field preferred.
• Previous experience in healthcare credentialing, provider enrollment, or healthcare administration, preferably in a US-based healthcare setting.
• Knowledge of credentialing standards, regulations, and processes, including CAQH, NPDB, and Medicare/Medicaid enrollment requirements.
• Familiarity with credentialing databases and software systems, such as NAMSS PASS, MD-Staff, or Cactus.
• Strong organizational skills, attention to detail, and the ability to manage multiple tasks and priorities effectively.
• Excellent communication skills, both verbal and written, with the ability to communicate diplomatically and professionally with internal and external stakeholders.
• Proficiency in Microsoft Office applications, including Word, Excel, and Outlook.
• Ability to work independently and collaboratively within a team, demonstrating flexibility and adaptability in a fast-paced healthcare environment.

Benefits:

• Competitive salary package with night shift differential.
• Opportunities for professional development and advancement.
• Supportive and collaborative work environment.
• Opportunity to contribute to the delivery of quality healthcare services in the US market.

Join our team as a US Healthcare Credentialing Specialist and play a vital role in ensuring the integrity and efficiency of provider credentialing processes

Job Types: Full-time, Permanent

Pay: From ₹40,000.00 per month

Benefits:

• Paid sick time
• Paid time off

Experience:

• total work: 2 years (Required)

Location:

• Mohali, Punjab (Required)

Work Location: In person