Requirements
Responsibilities:
Ensure accurate maintenance, verification, and processing of credentialing data for all practitioners as per the standards set by regulatory bodies.
Handle provider enrollment with insurance payers for all new and existing providers.
Serve as the primary contact for all issues related to provider credentialing and enrollment.
Develop and maintain strong professional relationships with providers, healthcare facilities, and payers.
Provide credentialing support during audits and compliance reviews.
Lead process improvement initiatives in the credentialing department.
Regularly update, maintain, and review the credentialing database ensuring data integrity.
Train and supervise junior credentialing staff, providing guidance and support as needed.
Qualifications:
Bachelor's degree in healthcare administration, business, or related field.
A minimum of 5 years of experience in healthcare credentialing and provider enrollment.
Knowledge of state, federal, and accreditation regulations related to credentialing.
Familiarity with National Committee for Quality Assurance (NCQA) standards and guidelines.
Proficiency with credentialing databases and Microsoft Office Suite.
Excellent communication and interpersonal skills.
Ability to multitask and prioritize in a high-volume, fast-paced environment.
Strong attention to detail, organizational skills, and ability to meet deadlines.