Credentialing Specialist Contracts

nimble solutions; Hyderabad; Hybrid; INR 500,000 - 700,000; Full time

Job summary

Nimble Solutions seeks an experienced credentialing specialist to manage end-to-end provider and facility credentialing for multiple client accounts. You will prepare and submit payer enrollment applications with Medicare, Medicaid, and major commercial payers, and verify licenses, NPI, DEA, CAQH, and other credentials.

You will maintain organized, audit-ready records, monitor status, and coordinate with internal teams to align credentialing with contracts and claim readiness.

Qualifications

• Associates or Bachelors degree preferred, preferably in Healthcare Administration or related field.
• Minimum 2 years of provider credentialing and payer enrollment experience.
• Strong knowledge of Medicare, Medicaid, and commercial payer processes.
• Hands-on experience with PECOS, CAQH, NPPES and payer portals.
• Facility credentialing experience is a plus.

Responsibilities

• Manage end-to-end provider and facility credentialing and recredentialing for client accounts.
• Prepare, submit, track, and maintain payer enrollment applications for Medicare, Medicaid, and major payers.
• Verify credentials: licenses, NPI, DEA, CAQH, board certs, and other docs.
• Maintain audit-ready credentialing records in databases and client systems.
• Monitor status and follow up with payers to minimize delays.
• Communicate with providers, facilities, payers, and internal stakeholders to resolve issues.
• Monitor expirations and initiate renewals to ensure uninterrupted participation.
• Collaborate with Contracting, RCM, and Billing to align credentialing with contracts.
• Provide regular status reports of credentialing progress to clients.
• Stay updated on CMS, Medicare/Medicaid, NCQA, and payer requirements.

Skills

Credentialing knowledge

Payer enrollment

Attention to detail

Multitasking

Communication skills

Microsoft Office

Education

Associate's degree or Bachelor's degree preferred

Tools

Microsoft Office Suite

Credentialing management systems

PECOS/CAQH/NPPES

Job description

Job Description:

Description

Responsibilities

• Manage end-to-end provider and facility credentialing and recredentialing processes for assigned client accounts.
• Prepare, submit, track, and maintain payer enrollment and participation applications for Medicare, Medicaid, and all major commercial payers.
• Verify provider and facility credentials, including state licenses, NPI, DEA, malpractice coverage, CAQH profiles, board certifications, accreditations,and other required documentation.
• Maintain accurate, organized, and audit-ready credentialing records within internal databases, payer portals, and client systems.
• Monitor application status and perform timely follow-ups with payers to ensure prompt approvals and minimize enrollment delays.
• Communicate effectively with providers, facilities, payers, and internal stakeholders to resolve credentialing and enrollment issues.
• Proactively monitor upcoming expirations and initiate renewals to ensure uninterrupted provider and facility participation in payer networks.
• Collaborate with Contracting, Revenue Cycle Management (RCM), and Billing teams to align credentialing activities with payer contracts and claim submission readiness.
• Prepare and share regular credentialing and enrollment status reports with clients, providing accurate updates on pending, approved, and outstanding items.
• Stay current with CMS regulations, Medicare and Medicaid guidelines, NCQA standards, and commercial payer credentialing requirements to ensure compliance.

Qualifications

• Associates or Bachelors degree preferred, preferably in Healthcare Administration, Business Administration, or a related field.
• Minimum 2 years of provider credentialing and payer enrollment experience, preferably within an RCM vendor, healthcare organization, or multi-client environment.
• Strong knowledge of Medicare, Medicaid, and commercial payer credentialing and enrollment processes.
• Hands-on experience with PECOS, CAQH, NPPES, payer portals, and credentialing/enrollment software.
• Facility credentialing experience is highly preferred and will be considered a Significant advantage.
• Strong understanding of provider and facility enrollment requirements for government and commercial health plans.
• Excellent organizational, documentation, and analytical skills with strong attention to detail.
• Ability to manage multiple client accounts, priorities, and deadlines simultaneously.
• Strong typing skills with the ability to maintain accurate and timely documentation.
• Excellent verbal and written communication skills, including the ability to professionally communicate with clients, providers, facilities, and payer representatives.
• Ability to independently prepare and present client status updates and credentialing progress reports.
• Proficiency in Microsoft Office Suite, including Excel, Word, Outlook, and credentialing management systems.

Preferred Skills

• Expertise in both Provider and Facility Credentialing.
• Strong working knowledge of Medicare, Medicaid, and all major commercial payers.
• Experience managing credentialing activities across multiple clients and payer networks.
• Client-facing experience with status reporting and stakeholder communication.

Ability to identify, troubleshoot, and resolve credentialing and enrollment issues