About the Role

We are seeking a detail-oriented Credentialing Specialist with 3+ years of experience to join our team. This role is responsible for managing the end-to-end credentialing and re-credentialing process for providers, ensuring compliance with regulatory, payer, and accreditation standards. The ideal candidate has robust organizational skills, a keen eye for detail, and experience navigating credentialing databases and payer enrollment systems.

Key Responsibilities

Process initial credentialing and re-credentialing applications for physicians, nurse practitioners, and other healthcare providers
Verify provider credentials, including licenses, education, board certifications, malpractice history, and work history through primary source verification (PSV)
Maintain accurate and up-to-date provider files in credentialing databases MD-Staff
Coordinate with payers to complete provider enrollment and ensure timely reimbursement eligibility
Track expiring licenses, certifications, and insurance to ensure continuous compliance




Prepare credentialing files for committee review and present findings as needed
Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal regulations
Respond to internal and external inquiries regarding provider credentialing status
Maintain confidentiality of sensitive provider information in accordance with HIPAA
Identify and resolve discrepancies in credentialing files in a timely manner
Support audits and provide documentation as requested

Qualifications

3+ years of credentialing experience in a healthcare, managed care, or hospital setting
Bachelor's degree preferred
Strong knowledge of credentialing standards (NCQA, URAC, CMS) and primary source verification processes
Experience with credentialing software/databases (CAQH, MD-Staff)
Familiarity with payer enrollment processes (Medicare, Medicaid, commercial insurers)
Excellent attention to detail and organizational skills
Strong written and verbal communication s

📌 Credentialling Specialist (Chennai)
🏢 Acurus
📍 Chennai