Credentialing Specialist

Position: Credentialing Specialist

Job Summary

We are seeking a detail-oriented and experienced Credentialing Specialist to manage provider credentialing, recredentialing, payer enrollment, and related activities. The ideal candidate should have experience working with US healthcare insurance payers and provider enrollment processes.

Key Responsibilities

Manage initial credentialing and recredentialing for physicians, therapists, and other healthcare providers.

- Complete and submit provider applications to Medicare, Medicaid, and commercial insurance payers.
- Maintain provider information in CAQH and other payer portals.
- Follow up with insurance payers regarding application status, missing documents, and approvals.
- Track credentialing and recredentialing timelines to ensure timely submissions.
- Manage provider enrollment, additions, terminations, and demographic updates.
- Maintain accurate credentialing files, provider records, licenses, certifications, and other required documents.
- Coordinate with providers and internal teams to obtain required documentation.
- Work with payer portals and systems such as CAQH, Availity, Medicare, Medicaid, and commercial payer websites.
- Prepare and maintain credentialing status reports and trackers.




- Identify and resolve credentialing-related issues, delays, and denials.
- Ensure compliance with payer, state, federal, and organizational requirements.

Required Qualifications

Minimum 2–5 years of experience in US healthcare provider credentialing and payer enrollment.

- Strong knowledge of Medicare, Medicaid, and commercial payer credentialing processes.
- Experience with CAQH and payer portals.
- Understanding of provider enrollment, revalidation, recredentialing, and contracting processes.
- Excellent communication and follow-up skills.
- Strong attention to detail and organizational skills.
- Ability to manage multiple providers and applications simultaneously.
- Proficiency in Microsoft Excel and other reporting tools.

Preferred Qualifications

- Experience in behavioral health or multi-specialty credentialing.

- Experience working with multiple state Medicaid programs.
- Knowledge of NPI, taxonomy, PECOS, and provider enrollment requirements.
- Experience working with RCM or medical billing organizations.

Employment Type

Full time

Skills

Credentialing | Provider Enrollment | CAQH | Medicare | Medicaid | Commercial Payors | Recredentialing | Payer Portals | Healthcare RCM

📌 Credentialing Specialist (Delhi)
🏢 Precise Softech India
📍 Delhi