Medical Summary jobs in Pune, Maharashtra

Position Summary:-

The Contract Credentialing Specialist is responsible for ensuring that healthcare providers are properly vetted, licensed, and enrolled with insurance payers (commercial and government) to ensure compliance and reimbursement eligibility. This role requires managing the end-to-end credentialing process, from initial application to network participation, often working remotely or on a project basis. Key Responsibilities

• Provider Enrollment & Credentialing: Complete and submit accurate provider applications (CMS-855, CAQH, state-specific forms) for insurance paneling and revalidation.
• Primary Source Verification (PSV): Verify provider education, training, work history, license, DEA, and board certifications to meet NCQA, Joint Commission, or state standards.
• Payer Follow-up: Proactively follow up with insurance carriers via email or telephone to track application status and expedite approval.
• Data Management: Maintain up-to-date, accurate provider data in databases, CAQH, or internal credentialing software.
• Contracting Support: Assist with the review and loading of provider contracts and fee schedules.
• Compliance & Audit: Ensure compliance with HIPAA regulations and internal quality management systems.
• License/Document Renewal: Track and renew expiring licenses, certifications, and malpractice insurance.

Required Qualifications & Skills:-

• Experience: Minimum 8-10 years of direct experience in provider credentialing, payer enrollment, and medical staff services.
• Technical Knowledge: Proficiency with CAQH, PECOS, NPPES, and major payer portals (e.g., Availity, NaviNet).
• Skills: Strong attention to detail, excellent written/verbal communication, and proficiency in MS Office (Excel/Word).
• Flexibility: Experience working in a 1099 or contract environment, often requiring high autonomy.

Job Type: Full-time

Pay: ₹50,000.00 - ₹80,000.00 per month

Work Location: In person