Job description

- To oversee the complete credentialing process for new and existing providers.
- Ensure all provider credentials are verified and maintained according to organizational policies and procedures.
- Coordinate with providers to obtain necessary documents and information.
- Maintain accurate credentialing records in the credentialing database/system.
- Ensure compliance with state, federal, and accrediting body requirements.
- Prepare, review, and manage contracts with providers, payers, and other healthcare entities.
- Ensure contracts are compliant with organizational standards and regulatory requirements.
- Track contract terms, renewals, and expirations.
- Serve as a liaison between providers, payers, and internal departments regarding credentialing and contract issues.
- Provide training and support to providers and staff on credentialing and contracting processes.
- Address and resolve provider inquiries and concerns promptly.
- Generate regular reports on the status of credentialing and contracting activities.
- Working closely with providers and organizations to provide guidance on compliance. Including responding to inquiries, staying up-to-date on credentialing requirements, and facilitating communication to resolve compliance issues.




- To ensure that physician licenses are renewed prior to expiration
- To complete primary source verification for recent and existing providers to ensure due diligence.
- Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Responsible of ensuring provider collected information is current and accurate.
- Responsible of coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.
- Keep track of the expiration date for the state DEA license, Board certification, and Malpractice insurance of individual providers. Job Types : Full-time, Fresher, Permanent

Pay: ₹10,622.11 - ₹12,434.02 per month

Advantages :

- Provident Fund

Education :

- Bachelor's (preferred)

Language :

- English (preferred)

Location :

- Nagpur City H.O, Nagpur, Maharashtra (preferred)

Shift availability:

- Night Shift (preferred)

Work Location: In person

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