Credentialing Specialist

Role Overview

We are looking for an experienced Credentialing Team Leader to manage end-to-end provider credentialing and insurance contracting processes for US healthcare clients.

The ideal candidate will have deep expertise in US healthcare credentialing, strong leadership skills, and the ability to manage teams and client expectations effectively.

Key Responsibilities

• Manage end-to-end credentialing & contracting for providers and groups
• Ensure providers maintain active status with Medicare, Medicaid, and commercial payers
• Oversee and update provider information in CAQH, PECOS, NPPES, CMS databases
• Handle initial credentialing, re-credentialing, and revalidation processes
• Maintain accurate provider records and internal trackers
• Coordinate with clients, physicians, and billing teams to resolve issues
• Track application progress and provide regular updates to clients
• Ensure compliance with payer requirements and deadlines
• Lead and guide the credentialing team for quality and efficiency

Key Skills & Competencies

• Strong knowledge of US provider credentialing and insurance contracting
• Hands-on experience with Medicare, Medicaid, and commercial payers
• Expertise in CAQH, PECOS, NPPES, CMS systems
• Excellent team management & communication skills
• Strong attention to detail and organizational abilities
• Ability to prioritize tasks and meet deadlines
• Advanced proficiency in Excel, Word, and internet tools

Experience Required

• Minimum 5-6 years of experience in end-to-end credentialing
• Prior experience in a lead or team handling role preferred