Credentialing Specialist

Precise Softech India; India; On-site; INR 300,000 - 700,000; Full time

Job summary

Precise Softech India is seeking a detail-oriented Credentialing Specialist to manage provider credentialing, recredentialing, payer enrollment, and related activities for US payers.

The ideal candidate will have 2–5 years of experience with CAQH, payer portals, and strong Excel and communication skills; familiarity with Medicare/Medicaid and commercial payers preferred. This is a Full-Time role based in India, with opportunities to coordinate across internal teams.

Qualifications

• Minimum 2–5 years of experience in US healthcare provider credentialing and payer enrollment.
• Strong knowledge of Medicare, Medicaid, and commercial payer credentialing processes.
• Experience with CAQH and payer portals.
• Understanding of provider enrollment, revalidation, recredentialing, and contracting processes.
• Excellent communication and follow-up skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple providers and applications simultaneously.
• Proficiency in Microsoft Excel and other reporting tools.

Responsibilities

• Manage initial credentialing and recredentialing for physicians, therapists, and other healthcare providers.
• Complete and submit provider applications to Medicare, Medicaid, and commercial insurance payers.
• Maintain provider information in CAQH and other payer portals.
• Follow up with insurance payers regarding application status, missing documents, and approvals.
• Track credentialing and recredentialing timelines to ensure timely submissions.
• Manage provider enrollment, additions, terminations, and demographic updates.
• Maintain accurate credentialing files, provider records, licenses, certifications, and other required documents.
• Coordinate with providers and internal teams to obtain required documentation.
• Work with payer portals and systems such as CAQH, Availity, Medicare, Medicaid, and commercial payer websites.
• Prepare and maintain credentialing status reports and trackers.
• Identify and resolve credentialing-related issues, delays, and denials.
• Ensure compliance with payer, state, federal, and organizational requirements.

Skills

Communication skills

Attention to detail

Organizational skills

MS Excel

Tools

CAQH

Availity

Payer portals

Job description

Job Description Credentialing Specialist

Position: Credentialing Specialist

Job Summary

We are seeking a detail-oriented and experienced Credentialing Specialist to manage provider credentialing, recredentialing, payer enrollment, and related activities. The ideal candidate should have experience working with US healthcare insurance payers and provider enrollment processes.

Key Responsibilities

• Manage initial credentialing and recredentialing for physicians, therapists, and other healthcare providers.
• Complete and submit provider applications to Medicare, Medicaid, and commercial insurance payers.
• Maintain provider information in CAQH and other payer portals.
• Follow up with insurance payers regarding application status, missing documents, and approvals.
• Track credentialing and recredentialing timelines to ensure timely submissions.
• Manage provider enrollment, additions, terminations, and demographic updates.
• Maintain accurate credentialing files, provider records, licenses, certifications, and other required documents.
• Coordinate with providers and internal teams to obtain required documentation.
• Work with payer portals and systems such as CAQH, Availity, Medicare, Medicaid, and commercial payer websites.
• Prepare and maintain credentialing status reports and trackers.
• Identify and resolve credentialing-related issues, delays, and denials.
• Ensure compliance with payer, state, federal, and organizational requirements.

Required Qualifications

• Minimum 2–5 years of experience in US healthcare provider credentialing and payer enrollment.
• Strong knowledge of Medicare, Medicaid, and commercial payer credentialing processes.
• Experience with CAQH and payer portals.
• Understanding of provider enrollment, revalidation, recredentialing, and contracting processes.
• Excellent communication and follow-up skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple providers and applications simultaneously.
• Proficiency in Microsoft Excel and other reporting tools.

Preferred Qualifications

• Experience in behavioral health or multi-specialty credentialing.
• Experience working with multiple state Medicaid programs.
• Knowledge of NPI, taxonomy, PECOS, and provider enrollment requirements.
• Experience working with RCM or medical billing organizations.

Employment Type

• Full-Time

Skills

Credentialing | Provider Enrollment | CAQH | Medicare | Medicaid | Commercial Payors | Recredentialing | Payer Portals | Healthcare RCM