US Healthcare Credentialing Specialist

2 weeks ago

Remote, India AmeriHealth Services Full time ₹ 2,40,000 - ₹ 4,80,000 per year

Job Summary:

We are seeking a detail-oriented and experienced Healthcare Provider Credentialing and Contract Management Specialist to manage the end-to-end credentialing process, payer enrollments, and contract lifecycle for individual and group healthcare providers. This role ensures timely and accurate provider onboarding, renewals, and maintenance of compliance with all regulatory, payer, and accreditation requirements.

Key Responsibilities:Credentialing:

  • Manage and complete initial and re-credentialing applications for healthcare providers with commercial payers, Medicare, Medicaid, and hospital networks.
  • Collect and verify required documentation including licensure, board certifications, malpractice insurance, DEA, NPI, and other credentials.
  • Maintain up-to-date CAQH profiles and respond to data attestation requirements.
  • Track credentialing and license expiration dates to ensure timely renewals.
  • Ensure compliance with NCQA, CMS, and payer-specific requirements.
  • Follow up with providers and payers to resolve delays and obtain approvals.

Contract Management:

  • Review, draft, and maintain managed care and payer contracts.
  • Negotiate contract terms in coordination with legal and finance departments.
  • Monitor contract effective dates, fee schedules, and rate changes.
  • Maintain a comprehensive database of contracts and credentialing documentation.
  • Ensure timely contract renewals and amendments are processed and documented.

Communication & Coordination:

  • Serve as the primary liaison between providers, payers, and internal departments.
  • Collaborate with billing, compliance, and operations teams to ensure enrollment data accuracy.
  • Provide regular credentialing status updates and reports to leadership.
  • Address provider inquiries and educate them on enrollment and credentialing requirements.

Required Qualifications:

  • Associate or Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent work experience).
  • 3 years of hands-on experience in healthcare provider credentialing and payer contract management.
  • Strong understanding of payer enrollment requirements, CAQH, PECOS, and provider types (MD, NP, PA, etc.).
  • Proficiency in managing and tracking credentialing status with Microsoft Office Suite.
  • Excellent organizational, analytical, and time management skills.
  • Strong written and verbal communication skills.

Preferred Qualifications:

  • CPCS or CPMSM certification through NAMSS (preferred but not required).
  • Experience with Medicare and Medicaid enrollments across multiple states.
  • Familiarity with RCM workflows and provider onboarding in small-to-mid-sized medical practices.

Key Competencies:

  • Attention to detail and accuracy.
  • Ability to work independently and handle multiple priorities under tight deadlines.
  • Problem-solving mindset with a proactive approach.
  • Confidentiality and professional integrity in handling provider and payer information.

Job Types: Full-time, Permanent, Contractual / Temporary
Contract length: 12 months

Pay: ₹20, ₹40,000.00 per month

Benefits:

  • Leave encashment
  • Paid sick time
  • Paid time off
  • Work from home

Schedule:

  • Monday to Friday
  • Night shift
  • US shift

Supplemental Pay:

  • Commission pay
  • Performance bonus

Application Question(s):

  • How many years of experience you have with provider credentialing?
  • What type of provider or group specialty have you worked in your previous projects
  • Which state rules are you familiar with or have experience with contracting?

Shift availability:

  • Night Shift (Preferred)

Work Location: Remote

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