Credentialing Specialist

3 days ago

Chennai, Tamil Nadu, India EL Revgen Healthcare Solutions Full time US$ 90,000 - US$ 1,20,000 per year

Job Summary:

We are seeking a dedicated and detail-oriented Credentialing Specialist with at least 2 years of experience working in a provider office. The ideal candidate will manage the full lifecycle of provider credentialing and payer enrollment processes to ensure timely billing and revenue recognition within the Revenue Cycle Management (RCM) framework.

Key Responsibilities:

  • Manage end-to-end provider credentialing and re-credentialing processes with commercial and government payers.
  • Complete payer enrollment applications for Medicare, Medicaid, and private insurers.
  • Maintain and update provider profiles in CAQH, PECOS, NPPES, and other relevant portals.
  • Liaise with providers to obtain, verify, and validate all required documentation (licenses, certificates, malpractice insurance, etc.).
  • Monitor and track credentialing expirations, license renewals, and re-attestation schedules.
  • Work closely with billing and compliance teams to ensure timely payer setup and claims processing.
  • Maintain accurate and up-to-date records in credentialing databases or software.
  • Ensure compliance with HIPAA, NCQA, JCAHO, and payer-specific standards.
  • Resolve enrollment issues and follow up on pending applications with payers and agencies.
  • Communicate credentialing status to providers, management, and RCM teams.

Required Skills & Qualifications:

  • Experience: 2 -4 years of hands-on experience in credentialing from a provider office setting.

  • Strong knowledge of:

  • CAQH, PECOS, NPPES

  • Medicare/Medicaid enrollment

  • Commercial payer requirements and portals (e.g., Availity)

  • Familiarity with RCM and its impact on credentialing.

  • Proficiency in MS Office tools (Excel, Word, Outlook).
  • Excellent verbal and written communication skills.
  • Strong attention to detail and ability to manage multiple tasks.
  • Understanding of credentialing compliance guidelines (HIPAA, NCQA, etc.).

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