Licensing and Payor Enrollment Specialist

DigiRecruitx; Pune District; On-site; INR 420,000 - 780,000; Full time

Job summary

DigiRecruitx is seeking a detail-oriented Licensing and Payor Enrollment Specialist in Pune to manage end-to-end provider enrollment across commercial payors and government health programs. You will ensure timely submission of applications, maintain provider records, and support onboarding and uninterrupted reimbursement.

The role requires 1–3 years in US healthcare payor enrollment or credentialing, strong communication, and proficiency with CAQH, NPPES, PECOS, and payer portals.

Qualifications

• 1–3 years of US Healthcare Payor Enrollment, Provider Enrollment, Credentialing, or related healthcare-operations role.
• Strong understanding of Medicare, Medicaid, and commercial payor enrollment processes.
• Experience with CAQH, NPPES, PECOS, and insurance payer portals is preferred.
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Excel, Word, and Outlook.

Responsibilities

• Complete and submit provider enrollment, revalidation, and re-enrollment applications with commercial and government payors.
• Manage provider enrollment through payer portals and application systems.
• Maintain and update provider information in CAQH and other enrollment databases.
• Track enrollment applications and follow up with insurance companies to ensure timely processing.
• Coordinate with credentialing, licensing, and operations teams to obtain required documentation.
• Resolve enrollment-related issues by communicating with payors and internal stakeholders.
• Maintain accurate records of application status, approvals, expirations, and renewals.
• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies.
• Prepare enrollment-status reports and maintain complete supporting documentation.
• Assist with provider onboarding and offboarding activities related to payor enrollment.

Skills

Healthcare payor enrollment

Provider enrollment

Credentialing

Communication skills

Attention to detail

Time management

MS Excel

MS Word

MS Outlook

Education

Bachelor's degree in any discipline

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

About the Role

We are looking for a detail-oriented and proactive Licensing and Payor Enrollment Specialist to manage end-to-end provider enrollment activities across commercial insurance payors, Medicare, Medicaid, and other government health plans.

The role is responsible for ensuring timely and accurate submission of enrollment applications, maintaining provider records, coordinating documentation, and supporting successful provider onboarding and uninterrupted reimbursement.

Key Responsibilities

• Complete and submit provider enrollment, revalidation, and re-enrollment applications with commercial and government payors.
• Manage provider enrollment through payer portals and application systems.
• Maintain and update provider information in CAQH and other enrollment databases.
• Track enrollment applications and follow up with insurance companies to ensure timely processing.
• Coordinate with credentialing, licensing, and operations teams to obtain required documentation.
• Resolve enrollment-related issues by communicating with payors and internal stakeholders.
• Maintain accurate records of application status, approvals, expirations, and renewals.
• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies.
• Prepare enrollment-status reports and maintain complete supporting documentation.
• Assist with provider onboarding and offboarding activities related to payor enrollment.

Required Qualifications & Skills

• Bachelor's degree in any discipline.
• 1–3 years of experience in US Healthcare Payor Enrollment, Provider Enrollment, Credentialing, or a related healthcare-operations role.
• Strong understanding of Medicare, Medicaid, and commercial payor enrollment processes.
• Experience working with CAQH, NPPES, PECOS, and insurance payer portals is preferred.
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Excel, Word, and Outlook.

Preferred Skills

• Knowledge of provider credentialing and licensing processes.
• Experience with healthcare practice-management or credentialing software.
• Strong analytical and problem-solving abilities.
• Ability to work independently while collaborating effectively with cross-functional teams.
• Familiarity with HIPAA compliance and healthcare regulations.

Why This Opportunity

• Opportunity to work in a growing US healthcare-services environment.
• Professional growth and learning opportunities.
• Collaborative and supportive work environment.
• Competitive compensation and performance-based growth.

Work Setup: Work from Office

Experience: 1–3 Years