Credentialing and Privileging Expert

22 hours ago

Rawalpindi Cantonment, Pakistan 24-7 Consultancy Full time

As a Medical Credentialing Specialist at 24-7 Consultancy, you will be responsible for ensuring the accuracy and completeness of provider information in our credentialing databases. This includes managing the credentialing and re-credentialing process, verifying education and licensure, and communicating with insurance companies and other healthcare organizations.

Main Duties
  • Credentialing and Re-Credentialing:
    • Manage the credentialing process, including obtaining and verifying necessary documentation (e.g., licenses, certifications, and education).
    • Maintain accurate and up-to-date provider information in credentialing databases.
  • Compliance:
    • Ensure compliance with state, federal, and payer regulations.
    • Monitor credentialing expirations and manage timely renewals of licenses, certifications, and insurance enrollments.
  • Verification and Communication:
    • Verify education, training, licensure, and work history through primary sources.
    • Communicate with insurance companies, hospitals, and other healthcare organizations to ensure provider enrollments are completed.
  • Database Management:
    • Maintain and update credentialing software and systems with accurate provider records.
    • Generate regular reports on credentialing status and compliance metrics for management review.
    • Work closely with providers, administrators, and third-party payers to resolve credentialing issues promptly.
    • Assist in streamlining credentialing workflows to enhance efficiency.
Requirements
  • Bachelor's degree in Healthcare Administration or related field.
  • Minimum of 1-2 years of experience in medical credentialing or a related role.
  • Knowledge of credentialing and privileging processes.
  • Familiarity with credentialing software and systems.
  • Strong attention to detail and organizational skills.
  • Excellent verbal and written communication skills.
  • Able to work independently and handle sensitive information confidentially.

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