The Credentialing Specialist manages the end-to-end provider enrollment and credentialing process for US-based physicians and healthcare practices. This role ensures providers are properly credentialed and enrolled with commercial payers, Medicare, and Medicaid so that claims can be billed and reimbursed without delay. The specialist works closely with US practice administrators, billing teams, and payer representatives to maintain compliance and minimize enrollment-related revenue disruptions.

Key Responsibilities

- Prepare, submit, and track initial credentialing and re-credentialing applications for physicians, NPs, PAs, and allied health providers with commercial payers (Aetna, Cigna, UnitedHealthcare, BCBS, etc.), Medicare, and Medicaid.
- Maintain and update provider data in CAQH, PECOS, NPPES, and payer-specific portals.
- Track expirable documents (licenses, DEA, malpractice insurance, board certifications) and proactively initiate renewals to avoid lapses.




- Manage payer contracting timelines, follow up on application status, and resolve delays or denials in enrollment.
- Coordinate with practices to gather required provider documentation (CVs, licenses, W-9s, malpractice face sheets, hospital privileges, etc.).
- Maintain accurate credentialing files and databases (provider rosters, effective dates, payer IDs) for audit readiness.
- Communicate directly with US-based payer representatives and internal billing teams regarding enrollment status and claim holds tied to credentialing gaps.
- Support facility/hospital privileging processes where applicable.
- Ensure compliance with NCQA, CMS, and payer-specific credentialing standards.
- Generate status reports for internal leadership and client practices on a weekly/monthly basis.

📌 Credentialing Specialist (New Delhi)
🏢 KHP Remote FTE
📍 New Delhi