Credentialing Specialist (US Healthcare)

We are seeking a detail-oriented Credentialing Specialist with at least 6 months of experience in US healthcare credentialing. The ideal candidate will have a strong understanding of the credentialing process and be capable of managing provider enrollments with various payers.

Key Responsibilities:

Handle end-to-end credentialing and re-credentialing processes for healthcare providers.

Prepare and submit applications for provider enrollment with insurance payers.

Verify and validate provider information, including licenses, certifications, and qualifications.

Maintain and update credentialing databases and ensure all records are current and accurate.

Communicate with insurance companies, medical boards, and providers to resolve credentialing issues.

Ensure compliance with regulatory and organizational policies during the credentialing process.

Generate regular reports and updates for the management team on credentialing status.

Required Skills and Qualifications:

Minimum 6 months of experience in US healthcare credentialing.

Familiarity with payer portals and credentialing software/tools.

Strong knowledge of credentialing guidelines, including CAQH and NPI processes.

Excellent verbal and written communication skills in English.

High attention to detail and organizational skills.

Ability to manage multiple tasks efficiently and work in a fast-paced environment.

Willingness to work in night shifts aligned with US timings. Read more