Job Description:
Job Role: Credentialing Associates/Senior Associates
Location: Hyderabad
Key responsibilities
- Application and verification: Complete and submit credentialing applications, verify provider credentials (licenses, board certifications, etc.) through primary source verification, and ensure all required information is accurate and complete.
- Payer and data management: Maintain provider data with insurance companies, update profiles in systems like CAQH, and manage enrollment with various payers (commercial, Medicare, Medicaid).
- Compliance and maintenance: Monitor credentialing timelines for re-credentialing and expirations, ensure ongoing compliance with state and federal regulations, and conduct audits to identify and mitigate risks.
- Problem resolution: Follow up with payers on application status, resolve missing information or exceptions, and address credentialing-related claim denials.
- Administrative duties: Maintain organized and confidential files, respond to inquiries, and assist with special projects as needed.
Essential skills and qualifications
- Experience: Previous experience in provider credentialing, RCM, or a related healthcare role is essential.
- Knowledge: Familiarity with relevant systems and databases (e.g., CAQH, NPPES, PECOS) and payer-specific requirements is crucial.
- Skills: Strong attention to detail, excellent organizational and communication skills, ability to work independently and meet deadlines, and proficiency with computer systems are required.
- Education: A bachelor's degree in Healthcare Administration or a related field is often required.
