Credentialing Operations Specialist

3 days ago

Rawalpindi Cantonment, Pakistan beBee Careers Full time

Job Title: Credentialing Operations Specialist

We are seeking a highly experienced and enthusiastic individual to fill this key role. The ideal candidate will have proven work experience in performing all new client account setups, research and development activities, ensuring that the credentialing requirements for government and commercial payers are met.

The successful candidate will be responsible for submitting and following up on submitted credentialing requests to all contracted commercial payers and government agencies.

Key Responsibilities:

  1. Leadership Experience: 3 to 5 years of experience in a credentialing department with at least 1 year of experience in a supervisory role.
  2. Credentialing Expertise: Experience in credentialing different specialties with major regular and private payers state-wise.
  3. Contract Management: Review the approval and termination of professional provider contracts as they relate to the credentialing process.
  4. Data Analysis: Ensure accurate and timely information for re-credentialing, data analysis, and directory generation, as well as recommending changes to the credentialing criteria and processes.
  5. Compliance: Maintain all credentialing and re-credentialing policies and processes to ensure compliance with all applicable regulations.
  6. Departmental Goals: Develop and implement departmental goals and objectives with input from staff members.
  7. Policies and Procedures: Develop and implement departmental policies and procedures that guide and support the provision of services.
  8. Customer Interaction: Interact with all customers to ensure prompt and accurate communication as needed to provide the service expected and to meet the goals of the service.

Job Rewards and Benefits:

  1. Paid Leaves: Enjoy paid leaves to recharge and relax.
  2. HR Bonus: Receive a bonus for outstanding performance.
  3. Inflation Bonus: Get a bonus to help combat inflation.
  4. Promotion: Opportunities for career advancement.
  5. Increments: Regular salary increments based on performance.
  6. Medical: Comprehensive medical coverage.
  7. Employee Equity Funds Program (EEFP): Participate in an employee equity funds program.
  8. Saturday and Sunday Off: Enjoy weekends off.
  9. Complementary Food: Enjoy complementary food and tea/green tea.

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