Credentialing Specialist

2 days ago

Noida, Uttar Pradesh, India Provana Full time ₹ 9,00,000 - ₹ 12,00,000 per year

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Key Responsibilities:

  • Credential Verification:

  • Conduct primary source verification of education, licenses, certifications, and work history.

  • Perform background checks including criminal records and disciplinary actions.

  • Compliance & Regulation:

  • Ensure compliance with NCQA, CMS, The Joint Commission, and other regulatory bodies.

  • Monitor expiration dates and initiate timely renewals of credentials.

  • Documentation & Database Management:

  • Maintain accurate records in credentialing software (e.g., CAQH, PECOS, NPPES).

  • Track and update provider profiles and credentialing logs.

  • Communication & Coordination:

  • Liaise with providers, payers, and internal departments to resolve discrepancies.

  • Respond to inquiries and facilitate credentialing-related communication.

  • Audit & Reporting:

  • Prepare for internal and external audits.

  • Generate reports on credentialing status and compliance metrics

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