Healthcare Professional

5 days ago

pune, India beBeeCredentialing Full time

Job Title: Credentialing Specialist – U.S. Healthcare Job Overview:The Credentialing Specialist is responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers contracted with various payers. This role requires strict compliance with regulatory guidelines to ensure timely provider onboarding and reducing claim denials.Key Responsibilities:Application Processing: Collect, evaluate, and process initial and re-credentialing applications while ensuring completeness and accuracy.Payer Enrollment: Submit and track enrollment applications with payers, resolving discrepancies to avoid delays and claim denials.Compliance & Audits: Ensure adherence to NCQA and regulatory standards. Prepare and present credentialing files for internal committee review and external audits.Communication & Coordination: Communicate with providers, internal teams, and payer agencies to resolve credentialing and enrollment inquiries efficiently.Expiration Tracking: Manage renewals of licenses, DEA, malpractice, and board certifications with proactive reminders.Issue Resolution: Investigate and resolve credentialing-related errors impacting reimbursement or onboarding timelines.Required Qualifications:Bachelor's degree preferred / equivalent experience in healthcare administration.Minimum 3 years of experience in provider credentialing or payer enrollment within US healthcare.Experience handling IHCP (Indiana Health Coverage Programs) credentialing and enrollment is strongly preferred.Strong understanding of regulatory and accreditation standards.Strong MS Office skills (Excel reporting, trackers, dashboards).Benefits:Avoidance of delays and claim denials through timely provider onboarding.Ongoing professional development and growth opportunities.A collaborative work environment.

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