Operations Director

3 days ago

Noida, Uttar Pradesh, India beBeeCredentialing Full time ₹ 20,00,000 - ₹ 25,00,000

Credentialing Operations Manager

This role oversees daily credentialing operations, ensuring adherence to regulatory and payer guidelines.

The ideal candidate will have expertise in credentialing, provider enrollment, and US healthcare regulations, as well as strong leadership skills. This position requires excellent communication and problem-solving abilities, with proficiency in relevant software and reporting tools.

Key Responsibilities:

  • Lead the credentialing team, supervising daily operations and ensuring compliance with client, payer, and regulatory requirements.
  • Manage end-to-end provider enrollment and re-credentialing processes for insurance networks, hospitals, and healthcare facilities.
  • Review provider documentation for accuracy, completeness, and compliance before 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 maintain quality standards and productivity goals.
  • Analyze reports on credentialing status, performance metrics, and compliance indicators to identify areas for improvement.
  • Streamline credentialing workflows by coordinating with internal departments, clients, and third-party entities.
  • Stay up-to-date on payer policies, NCQA standards, and healthcare compliance regulations.

Required Skills:

  • Strong expertise in Credentialing, Provider Enrollment, and US Healthcare Regulations
  • Proven leadership and team management capabilities
  • Excellent communication and problem-solving skills
  • Proficiency in credentialing software and reporting tools

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