Provider Credentialing Specialist

As a Credentialing Executive at Indus Medica, you will play a vital role in ensuring compliance and accuracy in provider credentialing and enrollment processes. Your primary responsibility will be to work on the credentialing and enrollments ensuring that healthcare providers are properly credentialed with payers and meet all regulatory requirements. This position requires strong attention to detail, knowledge of credentialing standards, and the ability to navigate complex healthcare networks

Role & responsibilities

• Assess, evaluate, and interpret application and verification information to identify 'red flags' or areas of established non-compliance; communicate adverse, incomplete, or questionable data to appropriate parties and recommend appropriate course of action
• Complete credentialing applications to add providers to commercial payers, Medicare and Medicaid & any Federal Payer
• Credential new providers and re-credential current providers with Insurance Company
• Maintain individual provider files to include up to date information
• Governmental and commercial payer credentialing applications.
• Maintain internal provider grid to ensure all information is accurate and logins are available.
• Update each provider database file timely & routinely according to the schedule published by CMS.
• Apply for and renew annually all provider licenses.
• Complete revalidation request issued by government payers.
• Work closely with the Revenue Cycle Manager and billing dept. to identify and resolve any.
• Create and enter practitioner data into profile, CAQH, provider portal, PECOS applications and group applications in credentialing software and obtains missing information and/or
  documents required to complete credentialing
• Perform all aspects of initial credentialing, re-credentialing, and/or privileging, for the providers and/or clinical teams throughout the US.
• Collect and verify sensitive provider and/or clinician data through confidential sources; manage, upload, and maintain compliance documents in required systems; regularly review reports to monitor completion of applications.
• Manage incoming and outgoing communications between multiple parties while meeting policy timelines and updating the credentialing database
• Participate in preparation for Internal and external audits conducted for current and accurate provider and/or clinician information or delegation compliance; audit files based on internal standards and regulatory / accreditation requirements (e.g., CMS, DSHS, NCQA & JCAHO, DNV), if applicable.
• Negotiated contracts to ensure that provider reimbursement rates were fair
• and reasonable.
• End-to-end working knowledge of creating and maintaining provider details
• on CAQH, PECOS, Availity, Navinet, NPPES, and other provider portals
• New Application, renewal as needed all provider licenses; Professional, DEA,
• Controlled Substance, CLIA, etc.
• Remain current with the research, review and interpretation of applicable accreditation, licensing, and other regulatory requirements to ensure credentialing policies and policies continually meet requirements.
• Maintain documentation of credentialing activities, such as feedback received from fellow colleagues and review and escalate when needed

Preferred candidate profile

• Must be a graduate from reputed university.
• Willing to work in Night Shifts.
• Excellent verbal and written communication skills
• Expertise with Microsoft Office Word and Excel
• Proficient touch-typing skills.
• Ability to communicate effectively with diverse groups at all organizational levels
• Analytical and investigative mindset within the scope of the role.
• Ability to provide explanations and interpretations within area of expertise.
• Attention to detail with a high degree of accuracy.
• Analytical thinking, multitasking, and time management skills.
• Independence and teamwork capabilities.
• Proficiency in navigating multiple websites and databases.
• Demonstrated assertiveness in meeting deadlines

Perks and benefits

Depending upon the interview