Credentialing Specialist

Business Integrity Services, LLC; Tiruchirappalli; On-site; INR 250,000 - 450,000; Full time

Job summary

Business Integrity Services, LLC is seeking a detail-oriented Credentialing Specialist in India to manage provider credentialing, PSV, and onboarding. The role ensures compliance with state, federal, and organizational standards while maintaining accurate credentialing records.

The candidate will handle enrollment applications with insurance networks, Medicare, and Medicaid, track statuses, and coordinate with internal teams.

Qualifications

• Minimum 1+ years of experience in provider credentialing.
• Graduation in any discipline.
• Experience with credentialing software and databases (CAQH, PECOS).
• Familiarity with CMS, NCQA, and Joint Commission.

Responsibilities

• Conduct comprehensive provider credentialing, including collecting, reviewing, and verifying education, training, licensure, certifications, and work history.
• Perform thorough primary source verification (PSV) to validate provider qualifications and credentials.
• Manage the complete provider onboarding process, ensuring timely submission of required documentation.
• Ensure compliance with state, federal, and organizational regulations throughout the credentialing lifecycle.
• Prepare, complete, and submit applications for provider enrollment with insurance networks, Medicare, Medicaid, and for hospital privileges.
• Track application statuses, follow up on pending approvals, and communicate updates to stakeholders.
• Maintain accurate and up-to-date provider profiles in credentialing databases and systems.
• Monitor expiration dates for licenses and certifications, ensuring timely renewals.
• Act as a liaison between providers, insurance networks, regulatory agencies, and internal departments.
• Collaborate with physicians and healthcare staff regarding credentialing requirements and updates.
• Identify and resolve discrepancies or delays in credentialing or enrollment processes.
• Address provider inquiries and investigate complaints related to credentialing and enrollment.

Skills

Attention to detail

Organizational skills

Communication skills

Independent work

Education

Graduation in any discipline

Tools

CAQH

PECOS

Job description

We are seeking a detail-oriented Credentialing Specialist with strong experience in provider credentialing, onboarding, and primary source verification. The ideal candidate will be responsible for ensuring that all healthcare providers meet organizational, state, and federal standards while maintaining accurate and up-to-date credentialing records.

Roles and Responsibilities

• Conduct comprehensive provider credentialing, including collecting, reviewing, and verifying education, training, licensure, certifications, and work history.
• Perform thorough primary source verification (PSV) to validate provider qualifications and credentials.
• Manage the complete provider onboarding process, ensuring timely submission of required documentation.
• Ensure compliance with state, federal, and organizational regulations throughout the credentialing lifecycle.
• Prepare, complete, and submit applications for provider enrollment with insurance networks, Medicare, Medicaid, and for hospital privileges.
• Track application statuses, follow up on pending approvals, and communicate updates to stakeholders.
• Maintain accurate and up-to-date provider profiles in credentialing databases and systems.
• Monitor expiration dates for licenses and certifications, ensuring timely renewals.
• Act as a liaison between providers, insurance networks, regulatory agencies, and internal departments.
• Collaborate with physicians and healthcare staff regarding credentialing requirements and updates.
• Identify and resolve discrepancies or delays in credentialing or enrollment processes.
• Address provider inquiries and investigate complaints related to credentialing and enrollment.

Qualifications and Education Requirements

• Minimum 1+ years of experience in provider credentialing.
• Graduation in any discipline.

Preferred Skills

• Strong exposure to provider credentialing, onboarding, and primary source verification.
• Excellent attention to detail and strong organizational skills.
• Experience with credentialing software and databases (e.g., CAQH, PECOS).
• Familiarity with regulatory guidelines such as CMS, NCQA, and the Joint Commission.
• Ability to work independently, prioritize tasks, and meet deadlines.
• Strong communication skills to collaborate effectively with clients and internal billing teams.