Credentialing Administrator

2 weeks ago

Mumbai, Maharashtra, India beBeeCredentialing Full time ₹ 9,00,000 - ₹ 12,00,000

Job Description

We are seeking a highly skilled Credentialing Specialist to join our team. As a key member of our organization, you will play a critical role in ensuring the efficient and accurate credentialing process for healthcare providers.

Key Responsibilities:
  • Manage the end-to-end credentialing and re-credentialing process for providers with Medicare, Medicaid, and major commercial insurance payers.
  • Submit and track provider enrollment applications, group contracts, and facility participation agreements with federal and private payers.
  • Maintain and update CAQH profiles, NPPES, PECOS, Availity, and other portals with accurate provider information.
  • Work closely with payers to ensure credentialing timelines and compliance with state, federal, and payer-specific regulations.
  • Monitor and manage credentialing expirables (e.g., licenses, DEA, malpractice insurance) and ensure timely renewals.
  • Communicate effectively with providers, practice managers, billing teams, and payers to resolve enrollment issues and delays.
  • Keep internal systems updated with current credentialing status and documentation for audits and claims submission readiness.
  • Ensure compliance with industry standards including CMS guidelines, NCQA, URAC, and HIPAA.
  • Identify and coordinate any risk management, substance abuse and/or malpractice issues. Reviews files for any 'red flag' concerns.
  • Maintains strict confidentiality of all records, data and occurrences as condition of initial and/or continued employment.
Required Skills and Qualifications:
  • 2–4 years of payer credentialing experience in an RCM, MSO, or medical group setting.
  • Comprehensive understanding of federal payer systems (Medicare/PECOS, Medicaid) and major commercial payers.
  • Experience managing multi-state enrollments and working with provider rosters.
  • Proficiency with credentialing platforms and payer portals (CAQH, PECOS, NPPES, Availity).
  • Strong communication, documentation, and organizational skills.
  • Ability to handle a high volume of applications and meet tight deadlines.
  • Exceptional communication and telephone skills required, as well as a great deal of patience and understanding.
  • Experience working with physicians and/or senior executives preferred.
  • Possess a high level of self-confidence and persistence; maintain an assertive approach in dealing with providers.
  • Must possess excellent organizational skills and the ability to multi-task effectively.
  • Demonstrate the ability to prioritize heavy workload and work independently with minimal supervision.
  • Proficient computer and internet skills; familiarity with Microsoft Office software required.
  • Knowledge of medical terminology preferred.
Benefits:

As a valued member of our team, you will enjoy a comprehensive benefits package, including health, dental, and vision insurance, 401(k) matching, and paid time off.

Others:

Location: Mumbai Ghansoli Or Kerala Kochi (Complete WFO)

Shift: US Shift (6:30PM - 3:30AM)

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