Payor Credentialing Specialist

Brandflare Business Solutions; Bhopal; On-site; INR 600,000 - 1,000,000; Full time

Job summary

Brandflare Business Solutions is seeking a credentialing specialist to manage end-to-end enrollment for US healthcare providers. You will handle provider enrollment with Medicare, Medicaid, and commercial payers, and complete CAQH profiles.

The role requires 2–7 years of hands-on US credentialing experience, strong communication, and proficiency with Excel or Google Sheets to maintain trackers. This is a full-time on-site position with US business hours.

Qualifications

• 2–7 years of hands-on US credentialing experience.
• Strong knowledge of US insurance payers and enrollment procedures.
• Experience with CAQH ProView, PECOS, NPPES, and payer portals.
• Understanding of Medicare, Medicaid, and commercial credentialing.
• Excellent written and verbal communication skills.
• Strong follow-up, coordination, and problem-solving abilities.
• Proficiency in MS Excel and Google Sheets for credentialing trackers.
• Ability to manage multiple provider credentialing cases simultaneously.
• Strong attention to detail and ability to work independently.

Responsibilities

• Manage end-to-end credentialing and enrollment processes for US healthcare providers, physicians, and medical practitioners.
• Handle provider enrollment with commercial insurance companies, Medicare, and Medicaid.
• Complete and maintain CAQH profiles, including initial registration, re-attestation, and profile updates.
• Prepare, submit, and follow up on credentialing applications with various insurance payers.
• Work on provider enrollment applications for insurance networks such as Aetna, Cigna, UnitedHealthcare, BCBS, Humana, Medicare, and Medicaid.
• Verify provider licenses, NPI, DEA, malpractice insurance, education, board certifications, and other required credentials.
• Coordinate with insurance companies and payer representatives regarding application status, pending documents, and enrollment approvals.
• Maintain accurate records of credentialing applications, submission dates, follow-up activities, and approval statuses.
• Identify and resolve credentialing-related discrepancies, rejections, and application delays.
• Handle provider re-credentialing, demographic updates, and changes in practice locations or affiliations.
• Maintain credentialing trackers and provide regular status reports to management and clients.
• Ensure all credentialing activities are completed within defined turnaround times and compliance requirements.

Skills

US Credentialing

Provider Enrollment

CAQH ProView

PECOS

NPPES

Medicare/Medicaid

MS Excel

Google Sheets

Documentation

Communication

Attention to detail

Job description

Roles & Responsibilities

1. Manage end-to-end credentialing and enrollment processes for US healthcare providers, physicians, and medical practitioners.
2. Handle provider enrollment with commercial insurance companies, Medicare, and Medicaid.
3. Complete and maintain CAQH profiles, including initial registration, re-attestation, and profile updates.
4. Prepare, submit, and follow up on provider credentialing applications with various insurance payers.
5. Work on provider enrollment applications for insurance networks such as Aetna, Cigna, UnitedHealthcare, BCBS, Humana, Medicare, and Medicaid.
6. Verify provider licenses, NPI, DEA, malpractice insurance, education, board certifications, and other required credentials.
7. Coordinate with insurance companies and payer representatives regarding application status, pending documents, and enrollment approvals.
8. Maintain accurate records of credentialing applications, submission dates, follow-up activities, and approval statuses.
9. Identify and resolve credentialing-related discrepancies, rejections, and application delays.
10. Handle provider re-credentialing, demographic updates, and changes in practice locations or affiliations.
11. Maintain credentialing trackers and provide regular status reports to management and clients.
12. Ensure all credentialing activities are completed within defined turnaround times and compliance requirements.

Required Skills & Qualifications

• Minimum 2 - 7 years of hands-on experience in US Medical Credentialing and Provider Enrollment.
• Strong knowledge of US healthcare insurance payers and enrollment procedures.
• Practical experience with CAQH ProView, PECOS, NPPES, and payer portals.
• Understanding of Medicare, Medicaid, and commercial insurance credentialing.
• Excellent written and verbal communication skills.
• Strong follow-up, coordination, and problem-solving abilities.
• Good knowledge of MS Excel, Google Sheets, and credentialing trackers.
• Ability to manage multiple provider credentialing cases simultaneously.
• Strong attention to detail and ability to work independently.

Preferred Experience

• Experience working with US-based hospitals, clinics, medical practices, and healthcare providers.
• Knowledge of end-to-end provider enrollment and re-credentialing.
• Experience handling multiple specialties and insurance networks.
• Familiarity with US healthcare compliance and credentialing documentation.

Key Performance Indicators (KPIs)

• Number of credentialing applications successfully processed.
• Application accuracy and error-free submissions.
• Timely follow-ups and turnaround time.
• Number of provider enrollments and approvals.
• Reduction in pending applications and credentialing delays.
• Proper maintenance of credentialing records and trackers.

Working Conditions

• Full-time, work-from-office position.
• US business hours / assigned evening shift.
• Saturday and Sunday weekly off.