Credentialing Specialist

1 week ago


Ahmedabad, Gujarat, India LETS ENKINDLE SOFTSERV PRIVATE LIMITED Full time
Credentialing Specialist

At LETS ENKINDLE SOFTSERV PRIVATE LIMITED, we are seeking a highly organized and detail-oriented Credentialing Specialist to join our team. The ideal candidate will have a strong understanding of Medicaid regulations and MCO credentialing requirements, as well as excellent communication and organizational skills.

Key Responsibilities:
  • Medicaid and MCO Credentialing:
    • Manage the credentialing and re-credentialing process for healthcare providers, ensuring compliance with Medicaid regulations and MCO requirements.
    • Collect, verify, and process credentialing documentation for providers.
    • Maintain up-to-date knowledge of MCO policies and Medicaid credentialing requirements.
  • Medicare Credentialing:
    • Oversee the Medicare credentialing process for healthcare providers, ensuring adherence to federal guidelines.
    • Ensure providers meet all necessary qualifications for Medicare participation.
  • Regulatory Compliance:
    • Stay updated on relevant Medicaid, MCO, and Medicare regulations and guidelines.
    • Ensure compliance with state and federal laws governing credentialing processes.
  • Documentation Management:
    • Collect, review, and accurately maintain credentialing documentation, including licenses, certifications, and background checks.
    • Track credentialing timelines, ensuring timely renewals of provider credentials and licenses.
    • Ensure documentation is audit-ready and compliant with all regulatory requirements.
  • Communication & Collaboration:
    • Work closely with internal teams and external stakeholders to ensure a smooth credentialing workflow.
    • Serve as the primary point of contact for inquiries related to credentialing.
  • Data Management:
    • Use credentialing software to manage, update, and track provider credentialing data.
    • Conduct regular audits of credentialing files to maintain data accuracy.
Qualifications:

Associate's or Bachelor's degree in healthcare administration, business administration, or a related field preferred.

Skills:

  • Strong understanding of Medicaid regulations and MCO credentialing requirements.
  • Knowledge of Medicare credentialing processes.
  • Attention to detail and excellent organizational skills.
  • Strong written and verbal communication skills.
  • Ability to handle multiple tasks and meet deadlines.
  • Proficiency in credentialing software and systems.


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