Credentialing Specialist

Company: Healthcare Informatics Pvt. Ltd. (HIPL)

Location: Remote (Anywhere in India)

Salary: Competitive & based on experience

About the Company:

Healthcare Informatics Pvt. Ltd. (HIPL), established in 2006, is a leading healthcare services company specializing in Revenue Cycle Management (RCM), Medical Records Management, and Healthcare IT solutions. We serve medical billing companies, clinics, and hospitals by delivering high-quality services in Medical Transcription, Medical Billing & Coding, and Information Technology with integrated database applications.

Job Description:

We are seeking an experienced Credentialing Specialist with a strong background in provider enrollment and credentialing for multiple payers. The ideal candidate should have hands-on experience working on the provider side (for a clinic, group practice, or billing company), handling new enrollments, revalidations, and credentialing renewals with accuracy and efficiency.

Key Responsibilities:

• Manage provider enrollment and credentialing with Medicare, Medicaid, and commercial payers.
• Create, update, and maintain credentialing files for all healthcare providers.
• Prepare, complete, and submit credentialing and recredentialing applications accurately and on time.
• Maintain and update CAQH profiles, ensuring attestations are current.
• Utilize PECOS for Medicare enrollment and reassignments (855I, 855R, 855B).
• Perform regular follow-ups with payers to track application status and resolve pending issues.
• Ensure all provider credentials (licenses, DEA, NPI, malpractice certificates) are current and properly documented.
• Collaborate with internal teams to ensure providers are active and linked for claim submissions.

Required Candidate Profile:

• Minimum 5 years of experience in Provider Enrollment and Credentialing (on the provider or billing company side).
• Strong working knowledge of PECOS, CAQH, and Medicaid enrollment processes.
• Experience handling individual and group enrollments.
• Excellent communication, organization, and follow-up skills.
• Detail-oriented and proficient in MS Office (Excel, Word, Outlook).
• Ability to manage multiple providers and payers simultaneously.

Preferred Qualifications:

• Experience with multi-specialty medical or dental provider groups.
• Familiarity with RCM (Revenue Cycle Management) workflow.
• Prior experience in a medical billing or healthcare operations company.

Why Join Us:

• Opportunity to work with a growing healthcare team.
• Exposure to multiple payer systems and credentialing processes.
• Supportive and collaborative work culture.
• Competitive compensation and career growth opportunities.

Job Type: Full-time

Pay: From ₹480,000.00 per year

Benefits:

• Provident Fund
• Work from home

Application Question(s):

• After submitting a Medicaid enrollment, what steps do you take to ensure the provider is fully active and ready for billing?
• When you process a Medicare enrollment using PECOS, what is the difference between handling an individual provider application and a group reassignment (855R)?
• How do you maintain a provider's CAQH profile, and how does it impact the credentialing process?

Work Location: Remote