Job Title : RL6 Provider Credentialing SME Location : Remote (Across the Globe)
Job Type : Contract / Full-time / Temporary
Job Description :
We are seeking a highly experienced RL6 Provider Credentialing Subject Matter Expert (SME) to join our dynamic team. This role involves overseeing and optimizing the RL6 credentialing process, ensuring compliance with regulatory standards, and implementing process improvements within the provider credentialing system.
The ideal candidate will bring in-depth knowledge of the RL6 system, along with strong expertise in provider credentialing, healthcare regulations, and operational workflows.
Key Responsibilities :
- Lead the design, implementation, and optimization of RL6 Provider Credentialing modules.
- Ensure compliance with all regulatory requirements, including state and federal guidelines related to provider credentialing.
- Collaborate with stakeholders to assess current credentialing workflows, identify gaps, and recommend enhancements.
- Develop and execute training for internal teams on RL6 credentialing processes.
- Serve as the primary point of contact for escalations related to credentialing workflows.
- Generate and analyze reports using RL6 to monitor compliance, efficiency, and data integrity.
- Stay updated on industry trends, regulations, and best practices in provider credentialing.
- Provide subject matter expertise on RL6-related upgrades, system enhancements, and troubleshooting.
Required Qualifications :
- 5+ years of experience in provider credentialing in a healthcare setting.
- Expertise in RL6 (Risk Management Software) with deep knowledge of provider credentialing workflows.
- Thorough understanding of healthcare regulatory requirements such as NCQA, URAC, and Joint Commission standards.
- Experience working with credentialing software and systems, with strong proficiency in data analysis and reporting.
- Excellent communication skills and ability to collaborate effectively with cross-functional teams.
- Proven ability to lead system implementations, upgrades, and training sessions.
- Strong organizational skills and attention to detail.
Preferred Qualifications :
- Bachelor's degree in Healthcare Administration, Information Systems, or a related field.
- Project management experience, especially in healthcare technology implementations.
- Knowledge of CMS guidelines , payer credentialing requirements, and insurance regulations.
- Experience with SQL or reporting tools used within RL6 or other credentialing systems.
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