Quality - Credentialing | US Healthcare

2 days ago

Pune, Maharashtra, India R Systems International Full time ₹ 12,00,000 - ₹ 36,00,000 per year

Job Title: Quality - Credentialing

Department: Credentialing / US Healthcare Operations

Location: Pune

Job Summary:

As a Quality - Credentialing, you will be responsible for ensuring the accuracy, completeness, and compliance of credentialing processes for US healthcare professionals. Your role will focus on auditing credentialing files, validating documentation, and ensuring adherence to regulatory standards. You will work closely with credentialing associates to identify gaps, provide feedback, and support continuous improvement in credentialing quality and compliance.

Key Responsibilities:

  • Audit credentialing files and documentation to ensure accuracy and completeness.
  • Validate provider credentials including licenses, certifications, and work history.
  • Monitor compliance with federal and state regulations, payer requirements, and internal policies.
  • Identify discrepancies and provide actionable feedback to credentialing associates.
  • Maintain quality tracking logs and generate reports on audit findings and trends.
  • Collaborate with the Credentialing and Quality teams to develop and refine SOPs.
  • Assist in training and mentoring credentialing staff on quality standards and best practices.
  • Participate in internal and external audits and support remediation efforts.
  • Stay updated on changes in credentialing regulations and industry standards.
  • Contribute to process improvement initiatives to enhance credentialing efficiency and accuracy.

Mandatory Skills:

  • Strong understanding of Credentialing, Enrollment, and US Healthcare regulations.
  • Experience in quality assurance, compliance auditing, or credentialing operations.
  • Proficiency in credentialing software and databases.
  • Excellent attention to detail and analytical skills.
  • Strong communication and documentation abilities.

Skills to be Evaluated On:

  • Knowledge of credentialing and enrollment processes.
  • Ability to identify and resolve compliance issues.
  • Accuracy in documentation and data validation.
  • Familiarity with US healthcare standards and payer requirements.
  • Collaboration and feedback delivery skills.
  • Reporting and audit documentation capabilities.

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