Credentialing & Enrollment
CTB Solutions Pvt Ltd
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.