We are seeking a detail-oriented Credentialing Analyst responsible for verifying and validating healthcare provider credentials, ensuring compliance with regulatory standards, and identifying potential risks or discrepancies.
Key Responsibilities :-
- Perform primary source verification (PSV) of: Education, licenses, certifications, and work history.
- Identify red flags / risk indicators: License gaps, malpractice history, sanctions, etc.
- Ensure compliance with: US healthcare regulations and payer requirements.
- Maintain accurate and up-to-date provider records.
- Prepare credentialing files for hospital medical staff office review.
- Document all verifications in MODIO system: Texas Medical License, DEA, DPS, Board Certification, Malpractice, etc.
- Communicate with: Providers, clinics and leadership for updates and issue resolution.
- Handle credentialing & privileging workflows.
Required Skills :-
- 2+ years in US healthcare credentialing.
- Strong knowledge of: CAQH, NPPES, PECOS.
- Experience in: MODIO or similar credentialing systems.
- Understanding of: State licensing boards & DEA verification.
- Strong analytical & documentation skills.
- Excellent communication. (written & verbal)
Preferred:-
- Experience with hospital credentialing / MSO.
- Exposure to compliance audits or QA.
Pay: ₹30,000.00 - ₹45,000.00 per month
Benefits:
Work Location: In person
