Credentialing Executive

Job Title:CredentialingExecutive

Location:Bangalore

Overview:As aCredentialingExecutive you will play a crucial role in ensuring that our healthcare organization maintains compliance with regulatory standards and delivers highquality care by thoroughly vetting andcredentialinghealthcare providers. Your attention to detail understanding of healthcare regulations and ability to build strong relationships will be instrumental in facilitating thecredentialingprocess and maintaining accurate provider databases.

Responsibilities:

1. ProviderCredentialing:Manage thecredentialingprocess for healthcare providers including physicians nurse practitioners physician assistants and allied health professionals. This involves collecting verifying and evaluating provider credentials licenses certifications and other relevant documents to ensure compliance with organizational and regulatory standards.
   
2. Provider Enrollment:Coordinate provider enrollment with various insurance networks Medicare Medicaid and other payer organizations. Complete and submit enrollment applications accurately and in a timely manner to facilitate reimbursement for services rendered by credentialed providers.
   
3. Database Management:Maintain accurate and uptodate provider databases includingcredentialingfiles licensure information malpractice insurance coverage and other pertinent documentation. Ensure that all provider information is entered and updated incredentialingsoftware systems or databases.
   
4. Regulatory Compliance:Stay abreast of changes in healthcare regulations accreditation standards and payer requirements related to providercredentialingand enrollment. Ensure thatcredentialingprocesses align with industry best practices and regulatory guidelines including those set forth by organizations such as NCQA URAC and CMS.
   
5. Provider Relationships:Develop and maintain positive relationships with healthcare providers medical staff and internal stakeholders to facilitate thecredentialingprocess. Serve as a liaison between providers andcredentialingcommittees addressing inquiries resolving issues and providing support as needed.
   
6. Quality Assurance:Implement quality assurance measures to monitor the effectiveness and efficiency of thecredentialingprocess. Identify areas for improvement and implement corrective actions to enhance process efficiency accuracy and compliance.
   
7. Audits and Reviews:Prepare for and participate in internal and external audits reviews and accreditation surveys related to providercredentialingand enrollment. Ensure thatcredentialingdocumentation and processes meet audit requirements and support organizational compliance.
   
8. Training and Education:Provide training and education to healthcare providers and staff oncredentialingpolicies procedures and best practices. Foster a culture of compliance and accountability throughout the organization by promoting awareness ofcredentialingrequirements and expectations.
   

Qualifications:

• Bachelors degree in healthcare administration business administration or a related field (Masters degree preferred).
  
• Certification in healthcarecredentialing(e.g. CPCS CPMSM) highly desirable.
  
• Minimum of 35 years of experience in healthcarecredentialingand provider enrollment preferably in a managed care.
  
• Indepth knowledge of healthcare regulations accreditation standards and payer requirements related to providercredentialingand enrollment (e.g. NCQA CMS Medicare).
  
• Proficiency incredentialingsoftware systems (e.g. CAQH NAMSS) and Microsoft Office Suite.
  
• Strong analytical skills with the ability to review and interpret complexcredentialingdocuments and data.
  
• Excellent communication interpersonal and organizational skills.
  
• Detailoriented with a commitment to accuracy and quality assurance.
  
• Ability to work independently prioritize tasks and meet deadlines in a fastpaced environment.
  

Benefits:

• Competitive salary commensurate with experience
  
• Comprehensive benefits package including medical dental and vision coverage
  
• Retirement savings plan with employer match
  
• Paid time off and holidays
  
• Opportunities for professional development and advancement within the organization