Job DescriptionCompany: Credifide
nLocation: Mohali
nShift: US Timings
nWorking Days: Monday to Friday (On-site)
nJob Type: Full time
nRole Summary
nThe Credentialing Specialist is responsible for managing the end-to-end provider enrollment and primary source verification process for an assigned caseload of providers. This role ensures insurance panel applications, re-credentialing, and hospital privileging are completed accurately and on schedule, working closely with the Credentialing Team Lead on complex or escalated files.
nKey Responsibilities
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- Application Management: Prepare, submit, and follow up on initial credentialing and re-credentialing applications for various specialties (Medicare, Medicaid, and Commercial payers).n
- Primary Source Verification: Conduct primary source verification of provider education, licensure, certifications, and work history in line with NCQA and payer standards.n
- Data Management: Maintain accurate, up-to-date provider profiles in CAQH, NPPES, and PECOS.n
- Quality Control:
Review own applications for accuracy and completeness before submission to minimize delays or denials.n
- Payer Follow-up: Track submitted applications and follow up with payers to resolve pended applications, enrollment discrepancies, or missing information.n
- Compliance Monitoring: Monitor expiration dates for provider licenses, DEAs, and board certifications, and initiate timely renewals.n
- Reporting: Keep the centralized tracking database/spreadsheet updated with the current status of assigned provider files.n
- Collaboration: Escalate complex credentialing roadblocks or multi-state enrollment issues to the Team Lead/Manager as needed.n
nRequired Skills & Experience
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- Experience: 3-4 years of experience in medical credentialing and provider enrollment.n
- Knowledge: Working knowledge of NCQA standards, CMS guidelines, and state-specific payer requirements.n
- Technical Proficiency: Hands-on experience with CAQH ProVi