Credentialing And Enrollment

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.
  
  

• 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.