Job description
- To oversee the complete credentialing process for new and existing providers.
- Ensure all provider credentials are verified and maintained according to organizational policies and procedures.
- Coordinate with providers to obtain necessary documents and information.
- Maintain accurate credentialing records in the credentialing database/system.
- Ensure compliance with state, federal, and accrediting body requirements.
- Prepare, review, and manage contracts with providers, payers, and other healthcare entities.
- Ensure contracts are compliant with organizational standards and regulatory requirements.
- Track contract terms, renewals, and expirations.
- Serve as a liaison between providers, payers, and internal departments regarding credentialing and contract issues.
- Provide training and support to providers and staff on credentialing and contracting processes.
- Address and resolve provider inquiries and concerns promptly.
- Generate regular reports on the status of credentialing and contracting activities.
- Working closely with providers and organizations to provide guidance on compliance. Including responding to inquiries, staying up-to-date on credentialing requirements, and facilitating communication to resolve compliance issues.
- To ensure that physician licenses are renewed prior to expiration
- To complete primary source verification for new and existing providers to ensure due diligence.
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
- Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
- Assist new individual provider in completing application for National Provider Identifier (NPI)
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Responsible of ensuring provider collected information is current and accurate.
- Responsible of coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.
- Keep track of the expiration date for the state DEA license, Board certification, and Malpractice insurance of individual providers.
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Job Types: Full-time, Fresher, Permanent
Pay: ₹10,622.11 - ₹12,434.02 per month
Benefits:
Application Question(s):
- Are you a fresher?
- What is your salary expectations?
Education:
Language:
Location:
- Nagpur City H.O, Nagpur, Maharashtra (Preferred)
Shift availability:
Work Location: In person
