Company: Credifide Location: Mohali Shift: US Timings Working Days: Monday to Friday (On-site) Job Type: Full time

Role Summary The 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.

Key Responsibilities Application Management:

Prepare, submit, and follow up on initial credentialing and re-credentialing applications for various specialties (Medicare, Medicaid, and Commercial payers). Primary Source Verification:

Conduct primary source verification of provider education, licensure, certifications, and work history in line with NCQA and payer standards. Data Management:

Maintain accurate, up-to-date provider profiles in CAQH, NPPES, and PECOS. Quality Control: Review own applications for accuracy and completeness before submission to minimize delays or denials. Payer Follow-up:

Track submitted applications and follow up with payers to resolve pended applications,



enrollment discrepancies, or missing information. Compliance Monitoring:

Monitor expiration dates for provider licenses, DEAs, and board certifications, and initiate timely renewals. Reporting:

Keep the centralized tracking database/spreadsheet updated with the current status of assigned provider files. Collaboration:

Escalate complex credentialing roadblocks or multi-state enrollment issues to the Team Lead/Manager as needed.

Required Skills & Experience Experience:

3-4 years of experience in medical credentialing and provider enrollment. Knowledge:

Working knowledge of NCQA standards, CMS guidelines, and state-specific payer requirements. Technical Proficiency:

Hands-on experience with CAQH ProView, PECOS, and NPPES (NPI) portals. Proficient in Excel for data tracking. Communication:

Clear, professional communication skills for interacting with providers, office managers, and insurance representatives. Detail-Oriented:

Strong attention to detail to catch errors in provider documentation that could lead to claim denials.

📌 Credentialing Specialist (Sahibzada Ajit Singh Nagar)
🏢 Credifide
📍 Sahibzada Ajit Singh Nagar