Credentialing Specialist

Job Description About the Company WNS (Holdings) Limited (NYSE: WNS) is a digital-led business transformation and services company. WNS combines deep domain expertise with talent, technology, and AI to co-create innovative solutions for over 700 clients across various industries. WNS delivers an entire spectrum of solutions including industry-specific offerings, customer experience services, finance and accounting, human resources, procurement, and research and analytics to re-imagine the digital future of businesses. As of June 30, 2025, WNS had 66,085 professionals across 65 delivery centers worldwide including facilities in Canada, China, Costa Rica, India, Malaysia, the Philippines, Poland, Romania, South Africa, Sri Lanka, Turkey, the United Kingdom, and the United States. About the Role - Credentialing Specialist (US Healthcare) - Handle credentialing requirements for U.S. healthcare providers in the dental care space for in-network preferred providers. - Manage all aspects of credentialing, recredentialing, and privileging processes for healthcare providers. - Ensure providers meet all internal and external regulatory requirements, payer standards, and accreditation guidelines. - Maintain accurate provider files, coordinate with insurance payers, and support compliance and quality initiatives. - Coordinate and process initial credentialing, recredentialing, and privileging applications for physicians, allied health professionals, and other providers. - Conduct Primary Source Verification of state licenses, DEA, and board certifications. - Complete provider initial and recredentialing applications. - Verify provider credentials including education, training, licensure, board certification, work history, malpractice history, and references. - Maintain and update provider data in credentialing databases (e.g., CAQH). - Ensure compliance with regulatory, accreditation, and payer requirements including NCQA, CMS, Joint Commission, and state agencies. - Track license expirations, DEA certificates, malpractice insurance, and other credentials, and send timely renewal reminders. - Prepare and present completed files for Credentialing Committee and Medical Executive Committee review. - Coordinate payer enrollment and revalidation processes with insurance carriers. - Respond to internal and external inquiries regarding provider credentialing status. - Maintain confidentiality of provider information in accordance with HIPAA and organizational policies. - Assist in developing and updating credentialing policies and procedures. - Participate in audits and quality improvement initiatives as assigned. - Demonstrate hands-on experience in federal and commercial payer application submissions including Medicaid, Medicare, and commercial payers. Required Skills - Check Deal Log bi-weekly for new office opening dates. - Obtain IRS confirmation from the Development Department. - Confirm Owner/Billing Provider with the VP of Operations. - Verify current credentials on file for the Owner/Billing Provider. - Request NPI Type 2 (Billing Entity NPI). - Complete applications and contracts for the Billing Provider and submit for signatures. - Review signed contracts for accuracy. - Submit completed paperwork within 24 hours to applicable plans for approval and network acceptance. - Update the credentialing process on the Pending Log. - Follow up with dental plans. - Process billing changes (ownership changes, PC changes, TIN changes). - Credential owners, associates, and specialists as required. - Maintain Insurance Provider Status Reports and provider files with current credentials. - Manage inbound and outbound mail, including opening, sending, filing, and scanning. - Communicate issues and suggestions to improve processes. - Ensure compliance with company policies and with state, federal, and other regulatory bodies. Requirements - Qualifications - Any Graduate - Experience- Minimum 2 year - Preferred Experience- Dental credentialing Job Details: - Pay range - Pay Range - 4-6.5 Lacs P.A. - Work Mode - Work from Office - Shifts - 24*7 Night Rotational Shifts , 2 Days Rotational Offs - Work Location - DLF World Tech park DLF IT SEZ, NH8, Sector 30, Gurugram, Haryana 122001 Interview Details: - Mode: Walk-in only - Dates: 24th Nov to 28th Nov - Time: 11:00 AM to 4:00 PM - Venue: WNS, Tower A2, 11th Floor, World Tech Park, Sector 30, (Gurgaon) Note: Only Immediate Joiners are required.