Client Partner - Provider Credentialing
If you want to do more with your healthcare career and deepen your knowledge of healthcare Payer Services management, you have to look at your healthcare business processes from the customer’s lens. Get smarter about the business of healthcare, join a company that values your work and enables you to become a true partner to your clients by investing in your growth besides empowering you to work directly on KPIs that matter to your clients.
Start your career as a Client Partner for provider credentialing and enrollment services. We are always interested in talking to inspired, talented, and motivated people. Many opportunities are available to join our vibrant culture. Review and apply online below.
Job Location: MUMBAI, India
Provider Credentialing is a process used to evaluate the qualifications and practice history of a doctor. This process includes a review of a doctor's completed education, training, residency and licenses. It also includes any certifications issued by a board in the doctor's area of specialty. This also includes re-credentialing Process i.e. the process of periodically re-reviewing and re-verifying provider professional credentials in conjunction with the client’s credentialing criteria. This usually happens for every 3 years. Additionally, Provider Verification Process is performed which involves the verification of the information of the providers, who are Credentialed/Re-Credentialed and participating with the our Payer client periodically as per Department of Health and Human Services requirement.
Ensure that the most accurate information is available on the Payer website so that the right information will be available for the patients to avail services
Processes that are part of the role include - Provider Re-Credentialing, Organizational Credentialing, Provider Recruitment/Enrollment (Shell Creation)
Typical Provider information that is to be verified includes: Name, License details/ NPI / DEA, Tax id, Practice Locations, Specialty, Hospital Affiliations, OIG and NPDB report
Provider verification involves validation of the provider’s basic Information, Provider Specialty, Hospital Affiliations, Board Certification, Practice Location, Accepting Patients, Languages, and Malpractice
To be considered for this position, applicants need to meet the following qualification criteria:
10+2+3 (Graduation Mandatory) 2+ years equivalent experience of Credentialing and Provider Enrollment Processes
Experience with all of the following: PECOS, NCQA Standards as they relate to credentialing, CMS Regulations related to credentialing, and conducting web based research
Must be able to: Excel sort, filter, import / export data, basic formulas Word create and modify docs, mail merge Outlook manage emails and calendars
Excellent Communication Skills