Credentialing

2 weeks ago

Sahibzada Ajit Singh Nagar, India Medical Access Full time

Full Job Description

**Summary**:
The Credentialing Specialist, is accountable for leading and overseeing the collection of provider data and information to support the organization's credentialing and payer enrollment operations.

**Essential Duties and Responsibilities**:

- Develop credentialing processes and procedures, overseeing day-to-day implementation.
- Monitors process, and document all provider licenses and renewals, as well as credentialing for all state Medicaid and health plans accurately and in a timely manner prior to expiration.
- Monitor credentialing & licensing statuses for all licensed clinical providers, tracking re-credentialing requirements and creating new workflows as needed.
- Research and document required licenses and credentialing for company.
- Assist in resolving licensing and credentialing issues as needed.
- Maintain current and appropriate knowledge of provider licensing practices and Medicaid deadlines.
- Research and track state licensing and supervisory requirements for all states in which our company does business (MD, NP, PA, and PT)
- Track: CME requirements, supervisory agreements and regulations, licensure renewal and status, network status for providers
- Overseeing the completion of:

- CLIA and business certifications,
- TIN and set up,
- Medicare number acquisition, and
- Provider CAQH ProView profile
- Provide project management support to care team leadership on related projects.
- Responsible and accountable for maintaining compliance with all contractual obligations, state regulations and NCQA standards for activities related to the areas of responsibility.

Knowledge, Skills, and Abilities:

- Knowledge and understanding of local, state, federal laws and regulations pertaining to guidelines from Medicaid.
- Ability to document and analyze complex business requirements and
- Ability to manage complex projects and catalyze and energize teams with clear plans, accountabilities, and teamwork to efficiently execute.
- Ability to interface with Senior Level Executives during client meetings
- Must be a proactive, hands-on leader with a proven strategic vision who will drive operational performance with a high degree of accountability and integrity.
- Strong financial & data acumen - detail orientated, precision & proven track record managing budgets.
- Ability to be both a strategic and tactical change agent in the healthcare
- Self-starter who will take initiative and be proactive
- Strong interpersonal skills and ability to communicate
- Ability to create compelling and dynamic presentations.
- Ability to handle ambiguity and desire to work in a fast-paced start-up.

Pay: ₹25,000.00 - ₹40,000.00 per month

**Benefits**:

- Food provided
- Health insurance
- Paid sick time
- Paid time off
- Provident Fund

Schedule:

- Monday to Friday
- Weekend availability

Ability to commute/relocate:

- Sahibzada Ajit Singh Nagar, Punjab, Mohali - 160071, Punjab: Reliably commute or planning to relocate before starting work (required)

**Experience**:

- total work: 1 year (preferred)

**Language**:

- English (preferred)

Shift availability:

- Day Shift (preferred)

**Speak with the employer**
+91 8054125057

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