Key Responsibilities
- Handle provider credentialing and re-credentialing with commercial and government payers.
- Manage provider enrollment and maintain CAQH profiles.
- Coordinate with providers and internal teams for required documentation.
- Submit and track credentialing applications with insurance payers.
- Conduct regular follow-ups with payers to ensure timely approvals.
- Maintain accurate provider data and credentialing records.
- Monitor credential expiration and initiate renewals proactively.
- Verify licenses, certifications, malpractice insurance, and other provider documents.
- Work on payer enrollment, demographic updates, and contract loading as required.
- Ensure compliance with payer guidelines and credentialing regulations.
- Prepare and maintain credentialing status reports and MIS.
TL/TC Profile JD :
- Manage end-to-end provider credentialing and re-credentialing processes.
- Oversee payer enrollment for commercial and government insurance plans.
- Ensure timely completion and submission of credentialing applications.
- Maintain and monitor CAQH, NPI, PECOS, and payer portal updates.
- Verify provider licenses, certifications, malpractice insurance, DEA, and supporting documents.
- Track credentialing timelines and proactively manage expirations and renewals.
- Handle escalations and resolve credentialing-related issues with payers and providers.
- Ensure compliance with payer regulations and credentialing standards.
Team Leadership & Operations Management
- Lead, mentor, and support the credentialing team to achieve operational goals.
- Allocate work, monitor productivity, and manage daily team operations.
- Conduct regular quality audits and ensure process adherence.
- Provide training, coaching, and performance feedback to team members.
- Monitor SLA, TAT, productivity, and quality metrics.
- Prepare and review operational reports, dashboards, and MIS.
- Collaborate with management and cross-functional teams to improve workflow and process efficiency.
- Drive continuous improvement initiatives and implement best practices.
Pay: ₹35,000.00 - ₹150,000.00 per month
Benefits:
- Food provided
- Health insurance
- Leave encashment
- Provident Fund
Work Location: In person
