Job Title

1 week ago

Pune Maharashtra, India Credence Global Solutions Full time

**Department - Operations [RCM]**:
**Job Role**:
Accounts Receivable Executive is responsible for all aspects of credentialing and re-credentialing of health care professionals. This position ensures all health care professionals are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database & Fee schedule Negotiation. This position primarily works independently, but frequently coordinates with other team members, Credentialing Manager and Medical Director.
- Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements and company credentialing policies.
- Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
- Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
- Prepare and scan credentialing/re-credentialing files and other credentialing documentation into scanning software.
- Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.
- Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
- Answer credentialing telephone line and provide support to physicians, physician office staff, health plan contacts and company departments as necessary.
- Process provider network terminations, specialty/category changes, leave of absence requests.
- Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, vacation/PTO).
- Perform other related duties as assigned by management.
- Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
- Always maintain privacy and confidentiality.
- Maintain the credentialing database and ensure up-to-date information is always obtained.
- Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is needed.
- Ability to follow instructions and respond to Managements’ directions accurately.
- Demonstrates accuracy, organizational and problem-solving skills. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
- Maintain confidentiality.
- Work independently, prioritize work activities and use time efficiently.
- Must demonstrate and promote a positive team-oriented environment.
- Must be able to stay focused and concentrate under normal or heavy distractions.
- Must possess ability to manage change, delays, or unexpected events appropriately.
- Minimum 3 Years or Experience in US Health Care.

**Job Category**:Operations**Job Type**:Full Time**Job Location**:Pune IN

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