Job Description

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Job Role: Credentialing Team lead
Location: Hyderabad

Key responsibilities

Application and verification:

Complete and submit credentialing applications, verify provider credentials (licenses, board certifications, etc.) through primary source verification, and ensure all required information is accurate and complete.

Payer and data management:

Maintain provider data with insurance companies, update profiles in systems like CAQH, and manage enrollment with various payers (commercial, Medicare, Medicaid).

Compliance and maintenance:

Monitor credentialing timelines for re-credentialing and expirations, ensure ongoing compliance with state and federal regulations, and conduct audits to identify and mitigate risks.

Problem resolution:

Follow up with payers on application status, resolve missing information or exceptions, and address credentialing-related claim denials.

Administrative duties:

Maintain organized and confidential files, respond to inquiries, and assist with special projects as needed.

Essential skills and qualifications

Experience: 5+Years

Previous experience in provider credentialing, RCM, or a related healthcare role is essential.

Knowledge:

Familiarity with relevant systems and databases (e.g., CAQH, NPPES, PECOS) and payer-specific requirements is crucial.

Skills:

Strong attention to detail, excellent organizational and communication skills, ability to work independently and meet deadlines, and proficiency with computer systems are required. *

Education:

A bachelor's degree in Healthcare Administration or a related field is often required.