Provider Enrollment Senior Specialist

Sutherland; Hyderabad; On-site; INR 250,000 - 450,000; Full time

Benefits offered by this job

Night shift allowance

Sat/Sun fixed week offs

2-way cab facility

Self-transportation bonus

Job summary

Sutherland in Hyderabad is seeking a Credentialing Specialist to manage provider enrollment and re-credentialing across Medicare, Medicaid, and commercial payers. You will collect documentation, verify licenses and certifications, and coordinate with payers to obtain provider numbers and effective dates.

The role requires attention to detail, strong communication, and proficiency with enrollment software and MS Excel.

Qualifications

• Minimum 12 months of direct provider enrollment & credentialing experience in healthcare.
• Deep understanding of Medicare, Medicaid, and commercial payer enrollment requirements.
• Proficient in Microsoft Excel and enrollment software systems.

Responsibilities

• Prepare, submit, and track initial enrollment and re-credentialing paperwork for providers across payers.
• Collect and verify licenses, DEA numbers, NPI numbers, board certs, malpractice insurance, and CVs.
• Serve as main contact for plans; follow-up via phone, email, and portals to expedite provider numbers and dates.

Skills

Attention to detail

Communication skills

MS Excel

Enrollment software

Tools

CAQH

PECOS

NPI registry

Job description

Essential Functions and Responsibilities

• Application Management: Prepare, submit, and track initial enrollment applications and re-credentialing paperwork for all providers across various commercial and government payers (Medicare, Medicaid, etc.).
• Documentation & Verification: Collect and verify all required documentation, including licenses, DEA numbers, NPI numbers (Type 1 & 2), board certifications, malpractice insurance, and CVs, ensuring all information is accurate and up-to-date.
• Payer Communication & Follow-up: Act as the main point of contact for insurance plans. Conduct timely and consistent follow-up via phone, email, and payer portals to monitor application status, resolve discrepancies, and expedite the receipt of provider numbers/effective dates.
• Database Maintenance: Accurately enter and maintain all provider demographic and enrollment data in the credentialing database (e.g., CAQH, PECOS, internal systems) to ensure data integrity and compliance.
• Problem Resolution: Troubleshoot and resolve complex enrollment-related issues, claim denials due to credentialing reasons, and other discrepancies that arise during the enrollment cycle.
• Compliance & Reporting: Ensure all enrollment activities comply with state, federal (CMS), and organizational regulations (e.g., NCQA). Generate status reports on application volume, approval rates, and processing timelines for management review.
• Process Improvement: Identify bottlenecks or inefficiencies in the enrollment workflow and collaborate with management to develop process improvements and standard operating procedures (SOPs)

Required Skills and Qualifications

• Experience: Minimum of 12 Months of direct, hands-on experience in provider enrollment & credentialing within a healthcare setting.

Note: Experience solely in member enrollment or Payer credentialing is not applicable to this role.

• Knowledge: In-depth knowledge of Medicare, Medicaid, and commercial insurance carrier policies, procedures, and enrollment requirements.
• Familiarity with online provider databases and systems such as CAQH, PECOS, NPI registry, and state licensing boards.
• Exceptional attention to detail and organizational skills.
• Minimum of B1H communication rating required.
• Excellent written and verbal communication abilities to interact professionally with providers and payers.
• Proficiency in Microsoft Office Suite (especially Excel for tracking) and relevant enrollment software systems.
• Strong analytical and problem-solving skills to navigate complex payer guidelines

NOTE : FACE TO FACE INTERVIEWS ONLY!

Work Location:- Manikonda

Perks and Benefits

• Night shift Allowance (100 Per Working Day)
• Saturday and Sunday Fixed Week Offs.
• 2 Way Cab Facility (within 25 Km Radius).
• Self-transportation bonus upto 3500.