Process Associate - US Healthcare Credentialing Specialist

Great Media Technologies; Kolkata District; On-site; INR 600,000 - 900,000; Full time

Job summary

Great Media Technologies in Kolkata seeks an experienced US Healthcare Credentialing Specialist to lead end-to-end credentialing, re-credentialing, and payer enrollment for our US psychiatrists, NPs, and therapists. You will manage CAQH ProView profiles, track license expirations, and ensure HIPAA compliance while coordinating with US billing and payer relations to minimize enrollment delays.

Strong English communication and meticulous data management are essential to ensure flawless data

Qualifications

• Education: Bachelor’s degree in Healthcare Administration, Commerce, Business, or related field.
• Experience: 25 years of hands-on US Healthcare Credentialing and Provider Enrollment.
• Technical Knowledge: CAQH ProView, NPPES, PECOS, and state Medicaid portals.
• Familiarity with credentialing software and EHR platforms.
• HIPAA and US healthcare regulatory compliance knowledge.

Responsibilities

• Manage end-to-end credentialing and primary source verification (PSV) for psychiatrists, NPs, and clinicians.
• Create and update CAQH ProView profiles with 120‑day re-attestations.
• Track expiration dates for licenses, DEA, COI, board certs, and NPIs.
• Complete payer enrollment applications to commercial, Medicare, and Medicaid.
• Maintain provider roster statuses and collaborate with US Billing/RCM to resolve denials.

Skills

CAQH ProView

NPPES (NPI Registry)

PECOS (Medicare)

EHR platforms

English communication

Education

Bachelor's degree in Healthcare Administration/Commerce/Business

Tools

CAQH ProView

NPPES (NPI Registry)

PECOS (Medicare)

Medicaid portals

Job description

We are seeking an experienced and detail-oriented US Healthcare Credentialing Specialist to join our operational team in Kolkata. In this role, you will lead end-to-end credentialing, re-credentialing, and payer enrollment processes for our US-based psychiatrists, nurse practitioners, and therapists. You will serve as the primary liaison between our medical providers, state licensing boards, and commercial/government insurance payers (such as CAQH, Medicare, Medicaid, Aetna, BCBS, Optum, etc.) to ensure seamless onboarding and zero billing disruptions.

Key Responsibilities:

Provider Credentialing & CAQH Management

• Manage end-to-end credentialing and primary source verification (PSV) for newly hired psychiatrists, nurse practitioners, and licensed mental health clinicians.
• Create, update, and maintain comprehensive provider profiles on CAQH ProView, ensuring 120-day re-attestations are completed promptly.
• Track and maintain expiration dates for state medical licenses, DEA certifications, malpractice insurance (COI), board certifications, and NPI registrations.

Payer Enrollment & Contracting

• Complete and submit payer enrollment applications to commercial insurance carriers, Medicare, and Medicaid.
• Maintain active follow-ups with insurance payer provider relations departments to expedite enrollment and resolve application rejections or delays.
• Maintain a accurate, up-to-date roster of provider panel statuses per health plan.

Compliance & Data Integrity

• Perform Primary Source Verification (PSV) via state boards, NPDB (National Practitioner Data Bank), SAM/OIG sanction lists, and educational bodies.
• Ensure strict adherence to HIPAA guidelines and US healthcare regulatory requirements regarding practitioner documentation and privacy.
• Maintain the internal Credentialing Management System (CMS) and provider directory database with flawless data accuracy.

Collaboration & Communication

• Serve as the main point of contact for providers regarding documentation collection, background verification, and attestation sign-offs.
• Partner closely with the US Billing & Revenue Cycle Management (RCM) team to resolve enrollment-related claims denials and billing hold-ups.

Qualification & Experience Requirements

• Education: Bachelors degree in Healthcare Administration, Commerce, Business, or any related field.
• Experience: 25 years of hands-on experience in US Healthcare Credentialing and Provider Enrollment (Mental Health / Behavioral Health process experience is a strong plus).
• Technical Knowledge:
• Hands-on expertise with CAQH ProView, NPPES (NPI Registry), PECOS (Medicare), and state-specific Medicaid portals.
• Familiarity with credentialing software and Electronic Health Record (EHR) platforms.
• Deep understanding of primary source verification rules and standard US payer enrollment workflows.
• Communication: Exceptional written and spoken English skills to interact clearly with US insurance reps, state boards, and clinical providers.