Credentialing Manager

2 weeks ago

Chennai, Tamil Nadu, India Tag E Services Pvt Ltd Full time ₹ 50,000 - ₹ 5,00,000 per year

A Credentialing Manager is primarily responsible for overseeing and managing the process by which healthcare providers are verified and approved to deliver care within healthcare organizations, insurance networks, or medical facilities. Their role ensures compliance with regulatory standards, accreditation requirements, and internal policies. Here's a detailed breakdown of typical roles and responsibilities:

  1. Credentialing and Provider Verification

Verify the qualifications, licenses, certifications, and credentials of healthcare providers (doctors, nurses, allied health professionals).

Ensure compliance with state, federal, and payer-specific regulations.

Maintain accurate and up-to-date credentialing records.

Perform primary source verification of education, training, licensure, and work history.

  1. Compliance and Regulatory Oversight

Ensure compliance with accrediting bodies such as NCQA (National Committee for Quality Assurance), URAC, The Joint Commission, or state regulatory agencies.

Maintain knowledge of current laws, regulations, and industry standards related to provider credentialing.

Prepare for and facilitate audits or inspections by external regulatory agencies.

  1. Credentialing Process Management

Manage the end-to-end credentialing process, from provider application to approval.

Track expiration dates for licenses, certifications, and insurance coverage.

Oversee re-credentialing processes (usually every 2–3 years, depending on organization policies).

Handle credentialing for new hires, network providers, or contracted professionals.

  1. Communication and Coordination

Serve as the primary point of contact for providers, staff, and external entities regarding credentialing.

Coordinate with HR, compliance, legal, and payer departments.

Respond to provider inquiries and resolve credentialing issues or delays.

  1. Data Management and Reporting

Maintain credentialing databases and electronic filing systems.

Generate reports on credentialing status, compliance, and upcoming renewals.

Monitor key performance indicators (KPIs) related to credentialing efficiency and accuracy.

  1. Staff Supervision and Training (if applicable)

Supervise credentialing specialists or assistants.

Develop training programs for new staff on credentialing procedures and standards.

Ensure team members follow consistent processes and meet deadlines.

  1. Quality Improvement

Continuously review and improve credentialing processes.

Implement best practices to reduce errors and ensure timely provider approvals.

Stay informed of emerging trends, technologies, and tools in credentialing.

Skills & Qualifications Usually Required:

Knowledge of healthcare regulations, licensing, and accreditation standards.

Attention to detail and strong organizational skills.

Proficiency in credentialing software (e.g., CAQH ProView, symplr, Credentialing Hub).

Strong communication, negotiation, and problem-solving abilities.

Experience in healthcare administration or medical staff services.

Job Type: Full-time

Pay: From ₹50,000.00 per month

Benefits:

  • Food provided
  • Health insurance
  • Provident Fund

Ability to commute/relocate:

  • Chennai District, Tamil Nadu: Reliably commute or planning to relocate before starting work (Preferred)

Education:

  • Bachelor's (Preferred)

  • Credentialing Specialist

    2 weeks ago

    Chennai, Tamil Nadu, India Alina Telehealth Full time ₹ 4,00,000 - ₹ 8,00,000 per year

    Responsibilities:* Manage credentialing process from start to finish* Maintain accurate records and reports* Coordinate with healthcare providers and insurance companies* Ensure timely processing of applications

  • Credentialing Specialist(Provider Side)

    23 hours ago

    Chennai, Tamil Nadu, India Anicut Healthcare Solutions Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Job descriptionCredentialing Specialist(Provider Side)We are looking for a Experienced Credentialing Specialist(Provider Side) to join our medical billing team for the Mid shift. The ideal candidate will have 1-4 years of experience in medical billing with a strong focus on Credentialing Process(Provider Side).Job Role: Credentialing Enrollment(Provider...

  • Operation Associate

    5 days ago

    Chennai, Tamil Nadu, India Assured Full time ₹ 2,50,000 - ₹ 7,50,000 per year

    OverviewWe're seeking a Provider/Payer Enrollment to manage the critical process of enrolling and credentialing healthcare providers with various insurance payers, including commercial, Medicare, and Medicaid plans. This role is essential for ensuring providers are able to bill for services and for maintaining a healthy revenue cycle. The ideal candidate...

  • Team Lead

    7 days ago

    Chennai, Tamil Nadu, India Omega Healthcare Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Job Title: Team Lead - Credentialing - AR (RCM, US Healthcare)Location: ChennaiExperience: 5 to 10 YearsShift: Night ShiftNotice Period: 30 DaysJob Description:We are hiring a Team Lead - Credentialing - AR with 5+ years of experience in US healthcare credentialing to manage a team of 20+ members. The role involves overseeing day-to-day team operations,...

  • Associate Trainee

    2 weeks ago

    Chennai, Tamil Nadu, India iOPEX Full time ₹ 3,00,000 - ₹ 6,00,000 per year

    ResponsibilitiesManage the end-to-end credentialing, re-credentialing, and licensing for all healthcare providers and facilities.Execute provider enrollment and contracting with government and commercial insurance payers to ensure network participation.Maintain an accurate and compliant database of all provider credentials, licenses, and enrollment...

  • HR Manager

    2 weeks ago

    Chennai, Tamil Nadu, India Quess Corp Limited Full time ₹ 4,00,000 - ₹ 12,00,000 per year

    Manager - HR (Associate) Employer Description Quess Corp Limited (Quess) is India's leading business services provider, leveraging our extensive domain knowledge and future-ready digital platforms to drive client productivity through outsourced solutions. We provide a host of technology enabled staffing and managed outsourcing services across processes...

  • Procurement Manager

    1 week ago

    Chennai, Tamil Nadu, India Quess Corp Limited Full time ₹ 4,00,000 - ₹ 12,00,000 per year

    Manager - Procurement Employer Description Quess Corp Limited (Quess) is India's leading business services provider, leveraging our extensive domain knowledge and future-ready digital platforms to drive client productivity through outsourced solutions. We provide a host of technology enabled staffing and managed outsourcing services across processes...

  • Assistant Manager

    2 weeks ago

    Chennai, Tamil Nadu, India iMagnum Healthcare - Technology and Services Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Company DescriptioniMagnum Healthcare, based in Baltimore, MD, has over fifteen years of experience in healthcare revenue cycle management. We specialize in Physicians Billing, DME Billing Services, Healthcare IT, and Enterprise IT & Analytics. Our innovative solutions in Medical Billing, RPA, Machine Learning, and AI help increase transaction speed,...

  • Salesforce Order Management

    7 days ago

    Chennai, Tamil Nadu, India Aparajita Consultancy Services - IT Services Company Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    JD : Salesforce Order Management (SOM) - 7+ yearsLocation :Bengaluru, Hyderabad, Pune, Chennai, GurugramExperience : 7+ YearsTechnical design and end-to-end implementation of Salesforce Order Management (SOM) solutions, all the SOM related Objects and Workflows.Design and build orchestration flows for order capture, fulfilment, cancellation, return, and...

  • Deputy General Manager of Operations

    1 week ago

    Chennai, Tamil Nadu, India Quess Corp Limited Full time ₹ 15,00,000 - ₹ 25,00,000 per year

    Deputy General Manager - Operations Employer Description Quess Corp Limited (Quess) is India's leading business services provider, leveraging our extensive domain knowledge and future-ready digital platforms to drive client productivity through outsourced solutions. We provide a host of technology enabled staffing and managed outsourcing services...