RCM Credentialing Specialist - US

MDREV Solutions Pvt Ltd; Vadodara; On-site; INR 300,000 - 500,000; Full time

Job summary

An established industry player is seeking a dedicated RCM Credentialing Specialist to enhance the provider credentialing process. This role is pivotal in ensuring compliance with payer and regulatory requirements, facilitating timely reimbursements. The ideal candidate will have a keen eye for detail and strong communication skills, enabling effective collaboration with providers and insurance companies. Join a dynamic team where your contributions will directly impact revenue flow and operational efficiency. If you're passionate about healthcare and looking to grow in a supportive environment, this opportunity is perfect for you.

Qualifications

• 1+ years of experience in credentialing or provider enrollment.
• Strong knowledge of Medicare and Medicaid credentialing processes.

Responsibilities

• Coordinate all aspects of the provider credentialing process.
• Monitor credentialing timelines and follow up with providers.

Skills

Credentialing Processes

Provider Enrollment

Regulatory Compliance

Communication Skills

Microsoft Office

Education

Bachelor's Degree

Tools

CAQH

PECOS

Availity

Job description

MDREV Solutions Pvt Ltd Vadodara, Gujarat, India

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The RCM Credentialing Specialist is responsible for coordinating all aspects of the provider credentialing process, including initial credentialing, re-credentialing, and enrollment with insurance payers. This role ensures providers are properly credentialed and compliant with payer and regulatory requirements, enabling timely reimbursement and revenue flow.

Key Responsibility :

Collect, review, and submit all necessary documentation for provider credentialing and re-credentialing with insurance carriers and networks.

Maintain up-to-date knowledge of payer requirements and ensure compliance with state and federal regulations.

Monitor credentialing timelines and follow up with providers and payers to expedite the process.

Manage provider enrollment with Medicare, Medicaid, and commercial insurance plans.

Update and maintain provider records in credentialing databases (e.g., CAQH, PECOS, Availity).

Communicate regularly with providers, billing teams, and insurance companies to resolve issues or delays.

Track and report on the status of credentialing applications and ensure deadlines are met.

Collaborate with RCM teams to reduce denials related to credentialing issues.

Assist with audits and provide documentation as needed for compliance.

Qualification and Experience :

• Bachelor’s degree preferred; equivalent experience may be considered.
• 1+ years of experience in credentialing, provider enrollment, or a related RCM function.
• Strong knowledge of Medicare, Medicaid, and commercial insurance credentialing processes.
• Familiarity with credentialing systems (e.g., CAQH, PECOS) and payer portals.
• Excellent organizational skills and attention to detail.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Office (Word, Excel, Outlook).

Preferred Skills:

• Experience working in a healthcare or medical billing environment.
• Certification in credentialing (e.g., CPCS, CPMSM) is a plus.
• Ability to handle sensitive information with confidentiality and professionalism.
• Problem-solving mindset and ability to work independently

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

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