Credentialing Process Expert

2 days ago

Chennai, Tamil Nadu, India MINDTEL GLOBAL Full time ₹ 4,00,000 - ₹ 8,00,000 per year

Industry & Sector:
A technology-enabled healthcare provider services and healthcare BPO organisation operating across payer and provider networks. We support provider enrollment, network management, and regulatory compliance for healthcare customers across India. This on-site role is based in India and focuses on operational excellence in credentialing processes.

Standardized Title:
Provider Credentialing Specialist (Credentialing Process Expert)

Role & Responsibilities

  • Manage end-to-end provider credentialing lifecycle—collect, validate, and maintain credentialing packets and provider documentation to ensure timely enrollment and network participation.
  • Perform primary source verification (PSV) for licensure, education, board certification, DEA, and work history; document results and maintain audit-ready records in credentialing systems.
  • Prepare and submit enrollment and re-credentialing applications to CAQH, PECOS, state Medicaid, and commercial payers; monitor application status and resolve payer requests or deficiencies.
  • Maintain and reconcile provider data across directories and databases (NPI, TIN, specialty, rosters); update credentialing platforms and internal systems for accuracy.
  • Track expirations, alerts, and compliance requirements; coordinate renewals and remediation to prevent gaps in provider billing or network access.
  • Collaborate with provider relations, compliance, HR, and operations to implement process improvements, support audits, and meet NCQA/TJC readiness requirements.

Skills & Qualifications
Must-Have

  • Proven experience managing provider credentialing and enrollment processes, including re-credentialing and primary source verification.
  • Hands-on familiarity with CAQH ProView and PECOS payer portals.
  • Experience using credentialing systems and maintaining provider databases (e.g., Cactus, symplr or equivalent).
  • Strong working knowledge of NPI registry, state Medicaid enrollment, and payer-specific enrollment requirements.

Preferred

  • Understanding of NCQA/TJC standards and audit-readiness practices for credentialing.
  • Experience with verification vendors (e.g., Verisys) or advanced Excel / reporting skills for credentialing metrics and SLAs.

Benefits & Culture Highlights

  • On-site team environment with structured career paths in provider services and healthcare operations.
  • Opportunities for upskilling in payer enrollment platforms and compliance frameworks.
  • Competitive compensation, performance-linked incentives, and focus on operational excellence.

Location: On-site in India. If you are a meticulous operator with deep credentialing knowledge and a drive to streamline provider onboarding at scale, this role offers high impact and visibility across provider and payer engagements.

Skills: payer,healthcare,credentialing,microsoft excel,operational excellence,compliance,databases

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