- Manage end-to-end provider credentialing, re-credentialing, and payer enrollment processes.
- Collect, verify, and maintain accurate provider data including licenses, certifications, DEA, NPI, malpractice insurance, and work history.
- Submit and follow up on applications with insurance payers, hospitals, and healthcare networks.
- Ensure compliance with NCQA, JCAHO, CMS, and state/federal regulations.
- Maintain credentialing records in credentialing systems and provider databases.
- Track credential expiration dates and proactively manage renewals.
- Coordinate with providers, payers, internal teams, and hospital staff to resolve credentialing issues.
- Audit credentialing files regularly to ensure accuracy and completeness.
- Prepare reports and documentation for audits and internal reviews.
- Support onboarding of new providers by completing credentialing within defined timelines.
Required Qualifications
- 4 to 5 years of experience as a Credentialing Specialist or in a similar healthcare credentialing role.
- Strong knowledge of provider credentialing, payer enrollment, and medical staff regulations.
- Experience working with commercial payers, Medicare, and Medicaid.
- Familiarity with credentialing software and CAQH ProView.
- Excellent organizational and documentation skills.
- Ability to manage multiple providers and deadlines simultaneously.
- Strong written and verbal communication skills.
Job Types: Full-time, Permanent
Pay: ₹18,000.00 - ₹25,000.00 per month
Benefits:
Work Location: In person
