Credentialing | U.S Healthcare

Job Title-

Executive - AR ( Credentialing )

Job Description

As a Credentialing Associate at R Systems, you will play a pivotal role in ensuring the accurate and timely processing of credentialing applications for US healthcare professionals. Your expertise in regulatory compliance, attention to detail, and ability to manage multiple tasks will be critical in maintaining provider records and ensuring adherence to industry standards. You will conduct thorough background checks, verify licenses and certifications, and collaborate with internal teams to address credentialing issues. Additionally, you will stay informed about changes in healthcare regulations and help refine credentialing policies and procedures to enhance operational efficiency. Your contribution will directly impact the quality of healthcare services by ensuring that only qualified professionals are credentialed.

Roles & Responsibilities

Oversee credentialing processes, ensuring compliance with industry and regulatory standards.

Collect, review, and verify documentation such as licenses, certifications, and work history.

Maintain and update credentialing databases with accurate and current provider information.

Track credentialing status, expirations, and re-credentialing timelines using software tools.

Act as the primary contact for healthcare providers, guiding them through the credentialing process.

Collaborate with internal teams, including HR and legal, to ensure credentialing requirements are met.

Conduct audits to identify areas for improvement and ensure compliance with policies.

Prepare detailed reports on credentialing activities and outcomes for leadership review.

Stay current with state and federal regulations to ensure compliance.

Assist in developing and implementing credentialing policies aligned with best practices and organizational standards.

If you have relevant experience please drop your CV at naresh.arya@rsystems.com