Credentialing Specialist

NationsBenefits India; Hyderabad; Hybrid; INR 450,000 - 650,000; Full time

Job summary

NationsBenefits India is seeking a Credentialing Specialist to oversee credentialing and re-credentialing for providers in our networks. You will communicate with hearing and vision care providers and collaborate with Provider Support, Hearing, and Vision operations teams.

The role requires attention to detail, strong organizational skills, and basic to intermediate Excel knowledge. This is a hybrid position with 4 days in-office and 1 day remote work.

Qualifications

• Bachelor’s or Associate’s Degree desired.
• Healthcare credentialing experience or experience with a managed care organization.
• Experience with provider relations or related healthcare field.
• Basic to intermediate knowledge of Microsoft applications.

Responsibilities

• Maintain records for credentialed providers and applications.
• Process, record, and track credentialing documents in processing systems.
• Manage follow-up calls and email communications.
• Monitor faxes and other data notifications to ensure timely processing.
• Coordinate with Credentialing Committee and take meeting minutes.

Skills

Managed care knowledge

NCQA credentialing

Microsoft Office

Quick learner

Team player

Education

Bachelor’s or Associate’s degree

Job description

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