SPE-Provider Credentialing

5 days ago

Hyderabad, Telangana, India Cognizant Full time US$ 90,000 - US$ 1,20,000 per year

Job Summary

Join our dynamic team as a Specialist in Provider Credentialing where you will leverage your expertise in healthcare products and credentialing processes to ensure compliance and efficiency. With 4 to 6 years of experience you will play a crucial role in maintaining the integrity of our provider network. This hybrid role offers the flexibility of night shifts allowing you to balance work and personal commitments effectively.

Responsibilities

  • Oversee the credentialing and re-credentialing processes for healthcare providers to ensure compliance with industry standards and regulations.
  • Collaborate with cross-functional teams to streamline credentialing workflows and improve operational efficiency.
  • Analyze provider data to identify discrepancies and implement corrective actions to maintain data accuracy.
  • Develop and maintain comprehensive documentation of credentialing procedures and policies.
  • Provide support and guidance to providers throughout the credentialing process to ensure a smooth and efficient experience.
  • Monitor and report on credentialing metrics to identify trends and areas for improvement.
  • Implement best practices in credentialing to enhance the quality and reliability of provider information.
  • Coordinate with external agencies and stakeholders to facilitate timely credentialing approvals.
  • Utilize healthcare product knowledge to optimize credentialing processes and ensure alignment with organizational goals.
  • Conduct regular audits of credentialing files to ensure compliance with internal and external standards.
  • Assist in the development and delivery of training programs for new team members on credentialing procedures.
  • Participate in continuous improvement initiatives to enhance the overall effectiveness of the credentialing department.
  • Ensure all credentialing activities are conducted in accordance with company policies and regulatory requirements.

Qualifications

  • Possess a strong understanding of healthcare products and their application in credentialing processes.
  • Demonstrate expertise in credentialing and re-credentialing within the healthcare domain.
  • Exhibit excellent analytical skills to assess provider data and identify discrepancies.
  • Show proficiency in developing and maintaining documentation of credentialing procedures.
  • Display strong communication skills to support providers and collaborate with cross-functional teams.
  • Have experience in monitoring and reporting on credentialing metrics.
  • Be adept at coordinating with external agencies for credentialing approvals.

Certifications Required

Certified Provider Credentialing Specialist (CPCS)

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