Credentialing Specialist

Credifide; Ratta Khera; On-site; INR 420,000 - 620,000; Full time

Job summary

Credifide in Mohali seeks a Credentialing Specialist to manage end-to-end provider enrollment and primary source verification. You will ensure timely applications for Medicare, Medicaid, and commercial payers while maintaining precise provider profiles in CAQH, NPPES, and PECOS.

Ideal candidates have 3–4 years of credentialing experience and strong knowledge of NCQA and CMS standards, with hands-on portal experience and excellent communication skills.

Qualifications

• 3–4 years of experience in medical credentialing and provider enrollment.
• Working knowledge of NCQA standards, CMS guidelines, and state payer requirements.
• Hands-on experience with CAQH ProView, PECOS, and NPPES portals.
• Proficient in Excel for data tracking.

Responsibilities

• Prepare, submit, and follow up on initial credentialing and re-credentialing applications.
• Conduct primary source verification of education, licensure, certifications, and work history.
• Maintain provider profiles in CAQH, NPPES, and PECOS.
• Review applications for accuracy to minimize delays or denials.
• Track submissions and follow up with payers on pending items.
• Monitor license and certification expirations and initiate renewals.
• Keep centralized tracking databases updated with current status.
• Escalate complex credentialing roadblocks to the Team Lead/Manager.

Skills

Credentialing

Provider enrollment

Data management

Attention to detail

Communication

Tools

CAQH ProView

PECOS

NPPES (NPI) portals

Job description

Job Description

Company: Credifide Location: Mohali Shift: US Timings Working Days: Monday to Friday (On-site) Job Type: Full-time

Role Summary The Credentialing Specialist is responsible for managing the end-to-end provider enrollment and primary source verification process for an assigned caseload of providers. This role ensures insurance panel applications, re-credentialing, and hospital privileging are completed accurately and on schedule, working closely with the Credentialing Team Lead on complex or escalated files.

Key Responsibilities

• Application Management: Prepare, submit, and follow up on initial credentialing and re-credentialing applications for various specialties (Medicare, Medicaid, and Commercial payers).
• Primary Source Verification: Conduct primary source verification of provider education, licensure, certifications, and work history in line with NCQA and payer standards.
• Data Management: Maintain accurate, up-to-date provider profiles in CAQH, NPPES, and PECOS.
• Quality Control: Review own applications for accuracy and completeness before submission to minimize delays or denials.
• Payer Follow-up: Track submitted applications and follow up with payers to resolve pended applications, enrollment discrepancies, or missing information.
• Compliance Monitoring: Monitor expiration dates for provider licenses, DEAs, and board certifications, and initiate timely renewals.
• Reporting: Keep the centralized tracking database/spreadsheet updated with the current status of assigned provider files.
• Collaboration: Escalate complex credentialing roadblocks or multi-state enrollment issues to the Team Lead/Manager as needed.

Required Skills & Experience

• Experience: 3-4 years of experience in medical credentialing and provider enrollment.
• Knowledge: Working knowledge of NCQA standards, CMS guidelines, and state-specific payer requirements.
• Technical Proficiency: Hands-on experience with CAQH ProView, PECOS, and NPPES (NPI) portals.
• Proficient in Excel for data tracking.
• Communication: Clear, professional communication skills for interacting with providers, office managers, and insurance representatives.
• Detail-Oriented: Strong attention to detail to catch errors in provider documentation that could lead to claim denials.