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Healthcare Credentialing Professional
3 weeks ago
About this Role
We are seeking a highly skilled professional with experience in managing provider enrollment, credentialing, and compliance with regulatory guidelines.
Key Responsibilities:
- Credentialing Management
- Verify and maintain accurate records of provider documentation, licenses, certifications, and affiliations.
- Provider Enrollment Coordination
- Coordinate with insurance companies, hospitals, and healthcare organizations for seamless provider enrollment.
- Regulatory Compliance
- Evaluate and ensure adherence to NCQA, CMS, and other regulatory requirements.
- Record Maintenance
- Maintain up-to-date records in credentialing databases.
- Communication
- Effectively communicate with providers regarding application status, missing information, or required updates.
- Audit Support
- Support audits, reporting, and quality improvement initiatives.
