Credentialing Specialist

Position Summary

The Senior Credentialing & Provider Enrollment Specialist manages the full lifecycle of provider credentialing, re-credentialing, and payer enrollment across the group's physicians and advanced practice providers. This role serves as a subject-matter expert, handles the most complex enrollment cases, ensures compliance with regulatory and payer requirements, and mentors junior staff. Accurate, timely credentialing directly protects the group's ability to bill and get reimbursed, so this role is central to revenue integrity.

Job Responsibilities:

• Manage initial credentialing and re-credentialing for physicians, NPs, PAs, and other providers, ensuring files are complete, accurate, and timely.
• Perform primary source verification (licensure, DEA, board certification, education, work history, malpractice coverage, sanctions/exclusion checks — OIG, SAM, NPDB).
• Maintain and update provider records in the credentialing database (e.g., CAQH, Modio, symplr, MD-Staff, or Verifiable).
• Complete and submit enrollment/revalidation applications for commercial payers, Medicare (PECOS), and Medicaid.
• Track enrollment status through approval, follow up aggressively on pending applications, and resolve delays or denials.
• Manage CAQH ProView profiles, attestations, and re-attestations for all providers.
• Coordinate group/entity-level enrollments, EFT/ERA setup, and payer-provider linkages.
• Monitor expirables (licenses, DEA, certifications, malpractice) and drive timely renewals to prevent lapses.
• Ensure adherence to NCQA, CMS, state, and payer-specific standards.
• Maintain audit-ready files and support internal and external audits.
• Serve as a liaison between providers, payers, billing/revenue cycle, and leadership.

Required Qualifications

• 1–5+ years of credentialing and payer enrollment experience, preferably in a physician group or multi-specialty setting.
• Strong working knowledge of CAQH, PECOS, NPPES, Medicare/Medicaid enrollment, and commercial payer processes.
• Familiarity with NCQA and CMS credentialing standards.

Pay: ₹400,000.00 - ₹700,000.00 per year

Benefits:

• Health insurance
• Leave encashment
• Paid sick time
• Provident Fund

Application Question(s):

• Are you comfortable with On site job at Ahmedabad location?
• Are you comfortable with 6 PM to 3 AM shift?
• How many years of experience you have Credentialing and Provider Enrollment?

Work Location: In person