Rahul Nair
Virar
Summary
Detail-oriented and results-driven Credentialing Process Team Lead with over 8 years of experience in healthcare credentialing and compliance. Proven track record of managing and mentoring teams, optimizing credentialing workflows, ensuring regulatory compliance, and improving operational efficiency. Strong interpersonal and communication skills, capable of building relationships with healthcare providers, insurance companies, and regulatory bodies.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Credentialing Process Team Lead
Viaante Business Solutions Pvt Ltd.
02.2024 - Current
- Lead a team of credentialing specialists in ensuring timely and accurate credentialing and recredentialing of healthcare providers
- Oversee the processing of initial credentialing applications, background checks, licensure verification, and maintenance of credentialing records in compliance with regulatory and accreditation requirements
- Coordinate and collaborate with internal departments such as Legal, HR, and Compliance to ensure seamless onboarding of healthcare providers
- Develop and implement policies and procedures to improve credentialing processes
- Conduct training and mentoring for new team members, providing ongoing support to enhance individual performance
- Prepare reports on credentialing status, audits, and compliance for leadership and external partners
- Monitor and ensure adherence to state and federal regulations, maintaining the organization’s accreditation status
Credentialing Specialist
Viaante Business Solutions Pvt Ltd
04.2017 - 01.2024
- Processed and verified credentialing applications for physicians, specialists, and allied health professionals
- Managed provider data in credentialing databases, ensuring accurate and up-to-date information
- Conducted primary source verifications of licenses, certifications, and malpractice insurance for healthcare providers
- Assisted with audits and regulatory compliance reviews, ensuring adherence to industry standards
- Responded to provider inquiries and resolved credentialing-related issues
Customer Service Associate
Convergys India Private Limited
10.2011 - 03.2017
- Provided high-quality customer service via phone, email, and chat to resolve inquiries and issues, ensuring customer satisfaction
- Assisted with troubleshooting, product inquiries, and billing issues, always maintaining a professional and helpful demeanour
- Managed customer complaints and escalations, finding quick and effective resolutions to complex issues
- Processed orders, returns, and exchanges accurately, adhering to company policies
- Collaborated with other departments (sales, technical support, etc.) to resolve customer issues and ensure seamless service delivery
- Maintained a high customer satisfaction score through diligent follow-up and personalized service
Education
Bachelor of science - IT
University of Mumbai
Mumbai01.2011
Skills
- Credentialing & Recredentialing
- Leadership & Team Management
- Compliance & Regulatory Requirements (NCQA, JCAHO, etc)
- Process Improvement & Workflow Optimization
- Cross-functional Collaboration
- Data Management & Reporting
- Risk Management
- Healthcare Contracts & Provider Relations
- Excellent Written & Verbal Communication
- Credentialing Softwares
- Microsoft Office Suite (Word, Excel, PowerPoint, Powerbi)
- Healthcare Management Systems (HMS)
- Database Management
References
Available upon request.
Professional Development
- Completed training in HIPAA Compliance, Risk Management, and Healthcare Regulations.
- Regular participation in MRM to stay updated on credentialing trends and best practices.
Languages
English
First Language
Hindi
Proficient (C2)
C2
Marathi
Upper Intermediate (B2)
B2
Accomplishments
- Awarded Project Pillar
- Employee of the year
- Training excellence
Certification
- HIPPA
- NCQA
- URAC
Timeline
Credentialing Process Team Lead
Viaante Business Solutions Pvt Ltd.
02.2024 - Current
Credentialing Specialist
Viaante Business Solutions Pvt Ltd
04.2017 - 01.2024
Customer Service Associate
Convergys India Private Limited
10.2011 - 03.2017
Bachelor of science - IT
University of Mumbai