Credentialing Specialist:
● Familiar in Family practice and Maintain compliance with all regulatory and accrediting institutions
● Design and maintain the development and enhancement of internal credentialing and managed care contracting processes.
● Release information to agencies and members of the public as required by law
● Monitoring and ensuring credentials documents are maintained and current.
● Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch.
● Coordinate data between internal and external systems, including licensures, CAQH, and NPPES.
● Proactively identify and resolve issues, coordinate resolutions, and identify educational opportunities.
● Maintain expertise in industry regulations (NCQA, URAC, State, Federal/CMS) and serve as the organization's regulatory subject matter expert.
● Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
● Maintains confidentiality of provider information.
● Provides enrollment with government and commercial payers.
● Monitoring and ensuring credentials documents are maintained and current.
● Data entry and follow up in credentialing software.
● Use payer credentialing systems and manage payer contracts.
● Release information to agencies and members of the public as required by law.
● Maintain a contract repository with rate sheets for revenue cycle staff.
● Develop and negotiate managed care contracts with payers.
● Monitor contract performance and compliance.
● Analyze financial and operational impact of contracts.
● Maintain relationships with managed care organizations.
● Ensure contracts align with organizational goals and regulatory requirements
● AR Calling and denial work as assigned
● Other duties as assigned.
Other Responsibilities:
● Displays a competent knowledge of CMS and insurance policy and procedures as well as Federal and State Regulations. Keeps current with available resources.
● Maintains confidentiality, proper boundaries and an ethical relationship with clients and co-workers accordingly to Company's policies.
● Ensures all provider records are maintained according to agency standards, policies and procedures.
● Completes annual educational program as required.
● Participates in the development of quality improvement activities designed to enhance agency and program services
● Performs Other Duties as Needed
Job Types: Full-time, Permanent
Pay: ₹25,000.00 - ₹40,000.00 per month
Benefits:
- Health insurance
- Leave encashment
- Life insurance
- Provident Fund
Application Question(s):
- How many years of experience do you have as a Credentialing Specialist?
- What is your current salary and your expected Salary?
- Are you an immediate joiner? Please mention your notice period?
Work Location: In person
