Medical Credentialing Specialist

Job Overview:

We are seeking a dedicated and detail-oriented Medical Credentialing Specialist to join our team. This role involves managing the credentialing process for healthcare professionals, ensuring they meet all required compliance standards, and facilitating the smooth operation of provider networks. The ideal candidate will have a strong understanding of healthcare regulations, attention to detail, and the ability to work with various stakeholders to ensure timely and accurate credentialing.

Key Responsibilities:

• Credentialing Process Management:
• Oversee the credentialing and re-credentialing process for healthcare providers, including physicians, nurses, and allied health professionals.
• Document Verification:

Ensure all documentation required for credentialing is complete, accurate, and submitted on time. This includes verifying licenses, certifications, education, training, and work history.

• Compliance Management:

Stay updated on federal, state, and payer-specific regulations, ensuring that all providers meet the necessary requirements to maintain network participation.Enter and maintain credentialing data into databases and systems, ensuring information is kept accurate and up-to-date.Act as the point of contact for healthcare providers, payers, and other stakeholders, addressing any issues or queries related to credentialing.Assist in internal and external audits to ensure all credentialing records are compliant with regulatory standards.Generate and analyze reports related to credentialing status and provider network participation.Qualifications:

• Data Entry & Maintenance:
• Communication & Liaison:
• Audit Support:
• Reporting:

• Education:
• Bachelor’s degree in Healthcare Administration, Business, or a related field (preferred, but not required).
• Experience:

At least 1-2 years of experience in medical credentialing, healthcare administration, or a related field.

• Knowledge:

Strong understanding of healthcare accreditation standards, including knowledge of NCQA, URAC, and CMS guidelines.

• Skills:
• Excellent organizational and time-management skills
• Strong attention to detail and problem-solving abilities
• Ability to communicate effectively with internal and external stakeholders
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint)
• Experience with credentialing software or databases (e.g., CAQH, VeriFide) is a plusPreferred Skills:

• Familiarity with healthcare payer networks and provider contracting.
• Knowledge of healthcare compliance regulations.
• Ability to work in a fast-paced, deadline-driven environment.

Why Join Us?

• Competitive salary and benefits package
• Opportunity for growth and professional development
• Collaborative and supportive work environment

Job Type: Full-time

Pay: ₹17,428.53 - ₹55,193.99 per month

Benefits:

• Health insurance
• Paid sick time
• Provident Fund

Work Location: In person