Add office photos
All Filters
23 Credence Resource Management Jobs
Executive[Credentialing] | Credence Global Solutions
3-8 years
Pune
1 vacancy
Executive[Credentialing] | Credence Global Solutions
Credence Resource Management
posted 2mon ago
Job Role Insights
Fixed timing
Key skills for the job
Job Description
Accounts Receivable Executive is responsible for all aspects of credentialing and re-credentialing of health care professionals. This position ensures all health care professionals are appropriately credentialed, which includes the responsibility of maintaining current information on file and within the credentialing database & Fee schedule Negotiation. This position primarily works independently, but frequently coordinates with other team members, Credentialing Manager and Medical Director.
- Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements and company credentialing policies.
- Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
- Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
- Prepare and scan credentialing/re-credentialing files and other credentialing documentation into scanning software.
- Data entry of new applications in the credentialing database.
- Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.
- Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
- Answer credentialing telephone line and provide support to physicians, physician office staff, health plan contacts and company departments as necessary.
- Process provider network terminations, specialty/category changes, leave of absence requests.
- Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, vacation/PTO).
- Perform other related duties as assigned by management.
- Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
- Always maintain privacy and confidentiality.
- Maintain CAQH (Council for Affordable Quality Health Care) database and application process.
- Maintain the credentialing database and ensure up-to-date information is always obtained.
- Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is needed.
- Ability to follow instructions and respond to Managements directions accurately.
- Demonstrates accuracy, organizational and problem-solving skills. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
- Maintain confidentiality.
- Work independently, prioritize work activities and use time efficiently.
- Must demonstrate and promote a positive team-oriented environment.
- Must be able to stay focused and concentrate under normal or heavy distractions.
- Must possess ability to manage change, delays, or unexpected events appropriately.
- Minimum 3 Years or Experience in US Health Care.
- Experience with CAQH (Council for Affordable Quality Health Care) database and application process.
Employment Type: Full Time, Permanent
Read full job descriptionPrepare for Executive roles with real interview advice
People are getting interviews at Credence Resource Management through
People are getting interviews through
(based on 19 Credence Resource Management interviews)
Job Portal
Referral
Recruitment Consultant
53%
26%
5%
16% candidates got the interview through other sources.
High
Confidence
?
High Confidence means the data is based on a large number of responses received from the candidates.
What people at Credence Resource Management are saying
Rating based on 11 Executive
reviews
Anonymous · Voice / Blended
in Pune
Likes
Attractive salary...
Dislikes
Pressure pressure n pressure
Read 11 reviewsExecutive salary at Credence Resource Management
reported by
77
employees
₹2
L/yr - ₹5.2
L/yr
28%
less
than the average Executive Salary in India
View more details
What Credence Resource Management employees are saying about work life
based on 550 employees
Strict timing
Alternate Saturday off
No travel
Night Shift
Credence Resource Management Benefits
View more benefits
Compare Credence Resource Management with
Vertex Customer Solutions
Compare
First Source
Compare
WNS
Compare
Sutherland Global Services
Compare
Genpact
Compare
EXL Service
Compare
Conneqt Business Solutions
Compare
Quatrro
Compare
HGS
Compare
Tech Mahindra
Compare
Quess
Compare
Reliance SMSL
Compare
IKS Health
Compare
IntouchCX
Compare
Alldigi Tech
Compare
Taurus BPO Services
Compare
Globiva
Compare
TTEC India
Compare
Jindal X
Compare
MiraMed Ajuba
Compare
Similar Jobs for you
Share an Interview