Credentialing Specialist
24 hours ago
Location: Chennai, India
Shift: Night Shift (US Healthcare Process)
Experience Required: 2–4 years in US Healthcare Credentialing
Department: Provider Enrollment & Credentialing
Reports To: Operations Head
About the Role
We are looking for a detail-oriented and proactive Credentialing Specialist to join our fast-growing Revenue Cycle Management team. The ideal candidate will be responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers, ensuring compliance with payer requirements, and maintaining up-to-date records to support timely enrollments and renewals.
Key Responsibilities
- Manage provider credentialing, re-credentialing, and enrollment with commercial and government payers (Medicare, Medicaid, BCBS, Aetna, Cigna, UHC, etc.).
- Complete and submit CAQH profiles, NPI applications, and payer enrollment forms accurately and within deadlines.
- Maintain an updated database of all provider information, including licenses, certifications, malpractice insurance, and expirables.
- Track and follow up with payers to ensure timely enrollment approvals and address any denials or rejections.
- Work closely with providers, practice managers, and internal teams to collect and verify credentialing documents.
- Update internal systems and communicate status reports to management and clients regularly.
- Ensure compliance with NCQA, CMS, and payer-specific guidelines.
- Assist in creating SOPs and process documentation to support scalability and efficiency.
Required Skills & Qualifications
- Bachelor's degree or equivalent.
- 2–4 years of hands-on experience in US healthcare credentialing or enrollment.
- Strong understanding of CAQH, PECOS, NPPES, Availity, and payer portals.
- Excellent communication and follow-up skills (both verbal and written).
- Strong organizational skills and attention to detail.
- Proficiency in MS Excel, Word, and basic CRM or RCM software tools.
- Ability to work in a fast-paced environment with minimal supervision.
Growth Opportunities
As part of a rapidly expanding RCM organization, the Credentialing Specialist will have opportunities to:
- Lead small teams as the process scales.
- Cross-train in Provider Enrollment, Eligibility, and Payer Contracting.
- Participate in automation and process improvement initiatives.
Job Types: Full-time, Permanent
Pay: ₹17, ₹45,131.84 per month
Benefits:
- Health insurance
- Paid sick time
Work Location: In person
