Credentialing Specialist

NationsBenefits, LLC; Hyderabad; On-site; INR 600,000 - 900,000; Full time

Job summary

NationsBenefits, LLC is seeking a Credentialing Specialist in Hyderabad to oversee provider credentialing and re-credentialing across networks. You will communicate with hearing and vision care providers and collaborate with multiple operations teams, ensuring accurate and timely credentialing data.

The role requires excellent organization, strong interpersonal skills, and basic-to-intermediate Excel knowledge.

Qualifications

• Bachelor’s or Associate’s Degree preferred.
• Healthcare credentialing experience or related field is preferred.
• Experience with managed care or provider relations is advantageous.
• Familiarity with NCQA credentialing processes is desirable.
• Proficiency in Microsoft Office applications.

Responsibilities

• Maintain credentialing and re-credentialing records for providers.
• Process, record, and track credentialing documents in systems.
• Manage follow-up calls and emails with providers.
• Coordinate with teams to reconcile credentialing data gaps.
• Draft and distribute credentialing approval letters.
• Attend Credentialing Committee meetings and take minutes.
• Serve as liaison with Credentialing Verification Organizations.

Skills

Interpersonal skills

Attention to detail

Problem-solving

Education

Bachelor’s or Associate’s Degree

Tools

Microsoft Office

Job description

Credentialing Specialist

Employment Type: Full-time

Location: Hyderabad

Experience: 3 to 5 Years

Joining: Immediate to 30 Days

Shift: US Shift / Night Shift - 5PM to 2AM IST

Work Model: 4 Days Work From Office, 1 Day Work From Home.

Objective and Overall Purpose:

Individuals in the Credentialing Specialist role will be responsible for overseeing the credentialing and re-credentialing of providers that participate in the various NationsBenefits provider networks. This individual will communicate directly with hearing and vision care providers and work collaboratively with the Provider Support, Hearing, and Vision operations teams. This role requires excellent interpersonal skills to communicate effectively. They must be a positive, energetic individual with strong organizational skills, attention to detail and ability to multi-task. Basic to intermediate knowledge of Excel is required.

Tasks and Responsibilities:

• Maintain records for individual rendering Providers who have been credentialed and/or have applied for credentialing.
• Process, record, and track Provider Credentialing documents and data in processing systems.
• Effectively manage follow up calls and email.
• Monitor faxes, files and other sources of incoming Provider data notifications to ensure that Provider credentialing data is processed in a timely manner.
• Communicate with providers to obtain updated documents as needed during and after credentialing process.
• Maintain and properly store both electronic and hard copies of credentialing files.
• Update provider records and review for completeness and accuracy.
• Synthesize and report on data related to credentialing status and attainment.
• Draft, send, track and update Provider credentialing approval letters.
• Review Provider applications prior to Credentialing Committee meetings to identify possible issues in applications.
• Coordinate with Network Accuracy Specialist to reconcile gaps in information on providers between our system and the Credentialing Report.
• Take minutes at monthly Credentialing Committee meetings and distribute them for record keeping and approval.
• Serve as a liaison with Credentialing Verification Organizations
• Other duties and special projects may be assigned based on business demands

Qualifications:

Desired Education

• Bachelor’s or Associate’s Degree desired

Preferred Experience

• Healthcare credentialing experience or
• Experience with a managed care organization or
• Experience with provider relations or
• Experience in a related healthcare field

Knowledge, Skills and Abilities

• Understanding of managed care preferred
• Familiarity with NCQA credentialing processes preferred
• Basic to intermediate knowledge of Microsoft Applications
• Quick learner and self-motivated
• Ability to work as a team member or independently
• Strong problem-solving skills
• Professional presentation and demeanor
• Outstanding organization skills