Provider Credentials Specialist_Chennai (Guindy)_WFO

Hiring for leading Healthcare client.

Position 1: Credentialing Specialist

Shift: Day Shift

Location: Chennai - Guindy

5 days working (Monday to Friday)

Only direct interview.

Interested candidate can share updated resume to yogeswarisugumar@bdo.in along with below details.

Current CTC:

Expected CTC:

Notice Period:

Current location:

Job Summary:

We are seeking a detailed-oriented and efficient Provider Credentials Specialist to join our medical billing team. The successful candidate will be responsible for managing the credentialing and re-credentialing processes for healthcare providers. This includes ensuring that all required documents are up-to-date, submitting applications to insurance companies, and maintaining the integrity of provider databases in compliance with state and federal regulations.

Key Responsibilities:

• Credentialing & Re-Credentialing:
• Complete initial credentialing and re-credentialing applications for healthcare providers with insurance carriers.
• Track and monitor provider credentialing status, ensuring timely submission of all required documents.
• Maintain up-to-date provider credentialing files and records.
• Insurance Carrier Liaison:
• Act as a liaison between healthcare providers and insurance companies, ensuring that all credentials are properly submitted, verified, and approved.
• Work with insurance carriers to resolve any issues or discrepancies related to provider credentials.
• Compliance:
• Ensure all credentialing activities comply with applicable regulatory requirements (e.g., HIPAA, CMS, state regulations).
• Verify the accuracy of the provider's background, licensure, and certifications.
• Monitor provider profiles and inform of any expirations, discrepancies, or issues requiring action.
• Database Management:
• Update and maintain provider information in the internal credentialing database.
• Ensure accurate and timely data entry for providers in various credentialing and billing systems.
• Coordination & Communication:
• Coordinate with internal teams (medical billing, coding, HR, etc.) to ensure all credentialing information is accurate and complete.
• Communicate effectively with providers regarding credentialing status, necessary steps, and required documentation.
• Reporting:

• Generate regular reports on credentialing status for management review.
• Track and maintain documentation of completed credentialing cycles.

Qualifications:

• Education:
• High School Diploma or equivalent required. Associate or bachelors degree in healthcare, business administration, or a related field preferred.
• Experience:
• At least 2 years of experience in medical credentialing or a related field (medical billing, healthcare administration, etc.).
• Familiarity with credentialing processes, insurance companies, and regulatory requirements.
• Experience with credentialing software and database management.
• Skills:
• Strong knowledge of medical terminology, credentialing standards, and healthcare regulations.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook).
• Excellent attention to detail and organizational skills.
• Strong communication skills (verbal and written).
• Ability to manage multiple tasks simultaneously and meet deadlines.

Preferred Skills:

• Knowledge of specific credentialing software or platforms like CAQH, PECOS, or others.
• Previous experience with insurance provider networks.