Role Description

Job Description – Provider Recredentialing Specialist Shift Time : 5:30pm to 2:30am IST Role Summary The Provider Recredentialing Specialist is responsible for managing the end-to-end recredentialing lifecycle for healthcare providers to ensure compliance with payer, regulatory, and accreditation requirements. The role focuses on periodic validation of provider credentials, documentation updates, and ongoing monitoring to maintain an accurate and compliant provider network. Recredentialing is a cyclical process that ensures providers continue to meet required standards through updated verification and monitoring activities. Key Responsibilities 1. Recredentialing Lifecycle Management Manage end-to-end provider recredentialing processes in line with payer and regulatory timelines Initiate recredentialing cases based on due dates, expirable, and renewal triggers Track and manage provider credential expirations (licenses, certifications, malpractice insurance) 2.



Documentation & Application Review Collect and review recredentialing applications via systems like CAQH or internal platforms Validate completeness and accuracy of provider documentation Follow up with providers for missing or inconsistent information 3. Primary Source Verification (PSV) Perform PSV for: Licensure Board certification Education & training Work history Validate data from authoritative sources (State Boards, NPPES, OIG, NPDB, etc.) Ensure compliance with regulatory and payer requirements 4. Background & Compliance Checks Conduct sanction and exclusion checks (OIG, NPDB, Medicare/Medicaid) Identify discrepancies, red flags, or compliance risks Escalate issues for further clinical or committee review 5. Provider Data Validation & Quality Checks Ensure accuracy of provider profile (specialty, affiliations, demographics, practice locations) Perform quality audits on completed credentialing files Maintain documentation integrity for audit readiness 6. Workflow Management & Productiv

📌 Associate II (Chennai)
🏢 UST
📍 Chennai