Credentialing Analyst

• Ensure ongoing compliance with regulatory standards, such as those set by the National Committee for Quality Assurance (NCQA). specific actions or procedures related to compliance.
• Efficiently perform all credentialing verification and Enrollment aspects with payers, including initial credentialing and re-credentialing to ensure current Enrollment and timely handoff.
• Participate in the development of internal credentialing & Enrollment processes·
• Keep records of licenses, credentials, insurance contracts and other documents of groups and individual providers. ·
• Establish a robust monitoring system to track expiring licensures, board certifications, and professional certifications. Implement proactive measures for timely renewals to prevent any lapses.
• Adhere to legal requirements for information release, ensuring compliance with privacy regulations. Clearly communicate the processes for releasing information to agencies and the public, emphasizing the importance of maintaining confidentiality. ·
• Use critical thinking skills to conduct Research, follow-up with the Insurance companies.
• Establish and communicate a clear timeline for responding to inquiries from clients, health plans, and internal stakeholders. Implement effective communication channels to ensure timely and comprehensive responses.
• Regularly update and maintain the CAQH profiles of assigned providers. Address any challenges in ensuring the accuracy and completeness of profiles and implement strategies for ongoing profile maintenance.
• Actively participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.

Job Type: Full-time

Pay: Up to Rs150,000.00 per month

Work Location: In person