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US Healthcare, FACETS, Credentialing,Provider Data Management, Contract Loading.

1.00 to 6.00 Years   Noida,Bangalore   24 Mar, 2025
Inspiration Manpower Consultancy Private Ltd
Job LocationNoida,Bangalore
EducationNot Mentioned
SalaryRs 3.5 - 8 Lakh/Yr
IndustryMedical / Healthcare
Functional AreaCustomer Service (International)Allied Health Services
EmploymentTypeFull-time

Job Description

    Job Overview:We are seeking a highly skilled and detail-oriented Credentialing and Provider Data Management Specialist to join our team. The ideal candidate will have experience with credentialing processes, provider data management, contract loading, pricing, and working with FACETS or similar healthcare management systems. This position is crucial in ensuring that our provider network is compliant, accurately loaded into the system, and properly aligned with pricing structures and contracts.Key Responsibilities:
    • Credentialing:
      • Process and maintain provider credentialing applications for new and existing healthcare providers, ensuring compliance with regulatory and contractual requirements.
      • Verify and track provider credentials through primary source verification, ensuring timely re-credentialing and ongoing monitoring of provider compliance.
      • Coordinate with internal and external stakeholders to resolve issues related to credentialing.
    • Provider Data Management (PDM):
      • Maintain accurate and up-to-date provider data in all applicable systems, ensuring data integrity across platforms.
      • Handle updates and changes to provider data, including provider demographics, specialties, and other relevant information.
      • Troubleshoot and resolve discrepancies related to provider data.
    • Contract Loading:
      • Accurately load and update provider contracts and agreements into the FACETS system and other provider network systems.
      • Ensure that all contract terms, rates, and provisions are correctly reflected in the system.
      • Work closely with the contracting team to ensure the smooth integration of new provider contracts.
    • Pricing:
      • Assist with pricing updates and ensure that pricing information is accurately reflected in the system.
      • Collaborate with the pricing team to ensure competitive and compliant provider reimbursement rates.
      • Support the development of reimbursement schedules based on contract terms.
    • FACETS System:
      • Use the FACETS system to manage provider data, contracts, credentialing, and pricing information.
      • Provide system support and troubleshooting for internal teams using FACETS.
      • Work with IT and system administrators to improve system functionality and streamline processes.
    Qualifications:
    • Bachelors degree in Healthcare Administration, Business Administration, or related field preferred.
    • years of experience in provider credentialing, data management, contract loading, and pricing in a healthcare environment.
    • Strong knowledge of provider data management, contracting, and pricing within healthcare.
    • Experience using FACETS or similar healthcare management software is required.
    • Familiarity with regulatory requirements, such as NCQA, URAC, CMS, and other accreditation standards.
    • Strong attention to detail, organizational skills, and the ability to multitask effectively.
    • Excellent communication skills, both verbal and written, with the ability to work collaboratively across departments.
    • Ability to analyze data, identify trends, and provide actionable insights.
    Contact Aditya :hidden_mobile / hidden_mobile / hidden_mobile /hidden_mobile /hidden_mobile /hidden_mobile

Keyskills :
credentialingus healthcarefacetspricingprovider data management

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