Credentialing Executive will be responsible to:

• Review the approval and termination of professional provider contracts as they relate to the credentialing process.
• Ensure the accurate and timely information for the purposes of re-credentialing, data analysis and directory generation as well as recommending changes to the credentialing criteria and processes.
• Maintain all credentialing and re-credentialing policies and processes to ensure that they are in compliance with and all applicable regulations.
• Develop and implement departmental policies and procedures that guide and support the provision of services.
• Interact with all clients to ensure prompt and accurate communication as needed to provide the service expected and to meet the goals of the service.
• Develop new ideas and/or systems with innovation and creativity.
• Lead by example and serves as a professional role model.
• Responsible for the continuous assessment and improvement of the quality of care and services provided.
• Adhere to all Compliance & Integrity Program rules and requirements
• Manage all New Client Account Setups, Research and Development activities.
• Manage VAS (value added services), provider enrollment, claims submission and various other projects.
• Train and guide team members on new challenges in healthcare industry along with a keeping a close coordination with providers (clients).

Mandatory Requirements:

• Minimum 3 years of recent credentialing experience is required. 
• Strong verbal & written communication skills and good in cross functional interactions & coordination