Healthcare Credentials Professional

2 days ago

Noida, Uttar Pradesh, India beBeeCredentialing Full time ₹ 12,00,000 - ₹ 24,00,000
Job Title:
Credentials Manager - Healthcare Department:
US Operations
Location: Noida
Experience Required: 6–10 Years

Employment Type:
Full-Time

Job Summary:

We are seeking a dynamic and experienced Credentials Manager to oversee and manage a credentialing team within the US healthcare domain.

The ideal candidate will be responsible for ensuring timely and accurate provider enrollment, re-credentialing, and compliance with payer and regulatory standards.

This role demands strong leadership, process optimization, and stakeholder management skills to maintain high levels of quality and client satisfaction.


Responsibilities:
Lead and supervise daily operations of the credentialing team, ensuring adherence to client, payer, and regulatory guidelines.
Manage end-to-end provider enrollment and re-credentialing processes with insurance networks, hospitals, and healthcare facilities.
Review provider documentation for accuracy, completeness, and compliance prior to submission.
Monitor turnaround times and ensure timely completion of credentialing tasks.
Serve as the primary escalation point for complex credentialing issues, collaborating with payers and providers for resolution.
Train, mentor, and evaluate team members to uphold quality standards and meet productivity goals.
Generate and analyze reports on credentialing status, performance metrics, and compliance indicators.
Coordinate with internal departments, clients, and third-party entities to streamline credentialing workflows.
Stay updated on payer policies, NCQA standards, and healthcare compliance regulations.
Identify and implement process improvements to enhance operational efficiency and client satisfaction.

Mandatory Skills:
Strong expertise in Credentialing, Provider Enrollment, and US Healthcare RegulationsProven leadership and team management capabilitiesExcellent communication and problem-solving skillsProficiency in credentialing software and reporting tools

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