Credentialing Specialist

9 hours ago


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

Credentialing Specialist Job Overview

As a Credentialing Specialist at LETS ENKINDLE SOFTSERV PRIVATE LIMITED, you will play a critical role in ensuring the compliance of our healthcare providers with Medicaid and Medicare regulations. Your expertise in Medicaid and MCO credentialing processes will be instrumental in managing and processing credentialing documentation for our providers.

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:

Ambitious and organized Credentialing Specialist with a strong understanding of Medicaid regulations and MCO credentialing requirements. Knowledge of Medicare credentialing processes is a plus.



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