Job Description

Job Role: Senior/Specialist - Credentialing Experience: 3-6 years Location: Hyderabad/Chennai Shifts timings: General (10AM to 7 PM IST) /Noon (3PM to 12AM IST). Job Summary: The Credentialing Specialist plays a vital role in ensuring the quality and safety of Healthcare delivery by verifying and maintaining the credentials of Healthcare providers. This involves collecting, reviewing and verifying information related to education, license, Certifications, and experience, ensuring compliance with regulatory and accreditation standards. Key Responsibilities: Conduct Primary Source verification by contracting licensing boards, educational institutions and other relevant entities. Responsible for data entry and maintaining provider information in online credentialing database and systems. [CAQH, DEA, Provider Profiles] Verify the accuracy and validity of provider credentials, licenses and certificates. Ensure compliance with federal, state, and organizational credentialing. Maintain accurate and up-to-date provider profiles in credentialing department. Track and monitor credential expiration dates and recredentialing timelines. Initiate and manage the recredentialing process for healthcare providers. Ensure providers meet ongoing credentialing requirements. Maintain accurate and organized records of credentialing activities Address credentialing inquiries and emails and resolves issues promptly Familiarity with CAQH, License validation, 24/7 coverage, Attestation date, Specialty verification, DEA and other external websites related to Credentialing. Collect and review initial Credentialing applications and supporting documentations. Responsible for monitoring development process and following up with providers as needed until confirmation of in network status has been received. Responsible for maintaining copies of current state license, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Required Knowledge/Skills: Familiar with provider credentialing and recredentialing requirements. Strong analytical computer and software skills Excellent interpersonal skills including excellent verbal and written communication skills Ability to demonstrate high degree of trust and confidentiality