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12 hours ago
We are looking for a skilled and detail-oriented Medical Credentialing Specialist to join our team at 24-7 Consultancy. The successful candidate will be responsible for managing the credentialing and re-credentialing process for healthcare providers, ensuring compliance with industry standards, regulatory requirements, and payer guidelines.
Key Responsibilities- Credentialing and Re-Credentialing:
- Manage the credentialing process from start to finish, 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.
- Collaborate with providers, administrators, and third-party payers to resolve credentialing issues promptly.
- Improve credentialing workflows to increase efficiency.
- Degree in Healthcare Administration or related field.
- Experience in medical credentialing or a related role.
- Knowledge of credentialing and privileging processes.
- Familiarity with credentialing software and systems.
- Strong organizational and communication skills.
- Able to work independently and handle sensitive information confidentially.
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Technical Support Expert
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Credentialing Specialist
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Provider Enrollment Coordinator
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