Credentialing Executive

1 week ago

Andheri Mumbai Maharashtra, India D Analytical Support Full time

**Key Responsibilities**:
**1. Credentialing Process Management**: Oversee and manage the end-to-end credentialing process for healthcare providers, including physicians, nurses, and allied health professionals. Ensure each provider is verified against applicable legal and regulatory requirements.

**2. Documentation & Compliance**: Ensure that all provider documentation, such as licenses, certifications, and training records, are complete, accurate, and submitted in accordance with state, federal, and institutional guidelines.

**3. Database Management**: Maintain and regularly update credentialing databases with current and accurate provider information. This includes ensuring timely updates of licensure status, certifications, and insurance credentials.

**4. Collaboration with Healthcare Institutions**: Interface with hospitals, insurance companies, medical groups, and licensing boards to manage the credentialing workflow and ensure that all necessary certifications and licenses are active and up to date.

**5. Verification**:Conduct primary source verification (PSV) for licensure, education, work history, and other qualifications for healthcare providers, ensuring all requirements are met before submission.

**6.Reports and Audits**:Support in generating and reviewing credentialing reports and conducting internal audits to ensure that all documentation is accurate and ready for external audits or accreditation bodies.

**7. Problem Resolution**: Proactively address discrepancies, issues, or delays in the credentialing process, escalating concerns to management when necessary, ensuring mínimal disruption to provider operations.

**Qualifications**:
Education: Bachelor’s degree in Healthcare Administration, Business, or a related field.
Experience: Minimum of 2 years of experience in credentialing, preferably in a healthcare setting.
Technical Expertise: Proficiency with credentialing software (e.g., MDTech, Cactus, Verity) and database management systems.
Compliance Knowledge: Familiarity with industry standards such as NCQA, URAC, JCAHO, and other regulatory bodies.
Skills: Exceptional attention to detail, analytical and organizational skills, with the ability to manage multiple tasks and prioritize effectively.

Pay: ₹10,000.00 - ₹30,000.00 per month

Schedule:

- Rotational shift
- UK shift

Ability to commute/relocate:

- Andheri, Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (required)

Application Question(s):

- Do you have experience with US Medical Billing?

**Experience**:

- Microsoft Excel: 1 year (required)
- total work: 2 years (required)
- Medical billing: 1 year (required)

Work Location: In person

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