Senior Credentialing Specialist

Key Responsibilities:

Credentialing & Enrollment

• Manage end-to-end credentialing and re-credentialing for healthcare providers (physicians, APPs, facilities).
• Prepare, submit, and track provider enrollment applications with commercial payers, Medicare, Medicaid, and managed care organizations.
• Ensure accuracy and completeness of credentialing documents including licenses, DEA, board certification, malpractice insurance, and education history.
• Maintain provider records in credentialing databases and CAQH.

Compliance & Quality

• Ensure compliance with NCQA, CMS, Joint Commission, state regulations, and payer requirements.
• Conduct primary source verifications and maintain audit-ready files.
• Monitor credentialing expiration dates and proactively initiate re-credentialing.
• Support internal and external audits and implement corrective actions when needed.

Provider & Payer Coordination

• Serve as the primary point of contact for providers, payers, and internal stakeholders regarding credentialing status.
• Resolve credentialing issues, delays, and denials by coordinating with insurance representatives.
• Communicate credentialing updates clearly and professionally to providers and leadership.

Leadership & Process Improvement

• Guide and mentor junior credentialing specialists.
• Assist in developing credentialing SOPs, checklists, and best practices.
• Identify process gaps and recommend improvements to enhance efficiency and turnaround time.
• Generate credentialing reports and metrics for management review.

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or a related field (preferred).
• 4–6+ years of healthcare credentialing and provider enrollment experience.
• Strong knowledge of payer enrollment processes (Medicare, Medicaid, commercial plans).
• Hands-on experience with CAQH, NPPES, PECOS, and credentialing software.
• Excellent attention to detail and organizational skills.
• Ability to manage multiple providers and deadlines simultaneously.
• Strong written and verbal communication skills.

Interested candidates, kindly share resume at [email protected]

Pay: ₹45,000.00 - ₹60,000.00 per month

Benefits:

• Provident Fund

Work Location: In person