he Credentialing Specialist is responsible for managing the credentialing, re-credentialing, provider enrollment, and payer participation processes for physicians and other healthcare providers. The role ensures that provider information, licenses, certifications, and payer enrollments remain accurate, complete, and compliant with applicable requirements.

Key Responsibilities

- Manage initial credentialing and re-credentialing for physicians, NPs, PAs, and other healthcare providers.

- Prepare and submit provider credentialing applications to commercial insurance companies, Medicare, Medicaid, and other payers.

- Maintain provider profiles in CAQH and ensure all required information and documents are current.

- Verify medical licenses, DEA certificates, board certifications, malpractice coverage, education, training, work history, and other credentials.

- Track credentialing applications from submission through approval and resolve application issues or missing information.

- Complete and maintain payer enrollment applications and participation agreements.

- Monitor provider credentialing and enrollment expiration dates and initiate renewals before deadlines.

- Maintain accurate credentialing records and supporting documentation.

- Communicate with insurance payer credentialing/enrollment departments regarding application status, discrepancies, and effective dates.

- Coordinate with providers to obtain missing documents and signatures.

- Update provider information when there are changes to address, tax ID, NPI, taxonomy, license, ownership, or practice affiliation.

- Maintain credentialing and enrollment trackers/reports.

- Support audits and provide credentialing documentation when requested.

- Ensure compliance with organizational policies, payer requirements, and applicable regulatory standards.

- Work closely with Billing, Medical Staff, HR, Compliance,



and Revenue Cycle teams to ensure providers are properly enrolled before claims are submitted.

Required Qualifications

- Bachelor's degree or equivalent experience preferred.

- 1–3+ years of experience in healthcare credentialing, provider enrollment, medical billing, or revenue cycle management.

- Knowledge of U.S. healthcare insurance and payer enrollment processes.

- Experience with CAQH, PECOS, NPPES/NPI, and commercial payer portals preferred.

- Understanding of Medicare, Medicaid, and commercial insurance credentialing requirements.

- Strong attention to detail and documentation skills.

- Good written and verbal communication skills.

- Ability to manage multiple providers, payers, and deadlines simultaneously.

- Proficiency with Microsoft Excel, Word, Outlook, and web-based payer portals.

Preferred Skills

- Experience with provider credentialing software or healthcare practice-management systems.

- Knowledge of CPT, ICD-10, taxonomy codes, NPI, TIN, and payer participation requirements.

- Experience with Medicare PECOS enrollment.

- Experience handling CAQH attestations and re-attestations.

- Familiarity with payer contracting and provider roster maintenance.

- Solid follow-up and problem-solving abilities.

Key Performance Indicators (KPIs)

- Credentialing applications submitted accurately and on time.

- Percentage of provider enrollments completed before start date.

- Timely completion of re-credentialing and renewals.

- CAQH profile accuracy and attestation compliance.

- Number of unresolved credentialing issues.

- Payer enrollment turnaround time.

- Accuracy of provider rosters and enrollment records.

Working Conditions

- Full-time position.

- Primarily office/remote administrative work.

- Requires regular communication with healthcare providers, payers, and internal departments.

- May require working with U.S. healthcare payer systems and U.S. business hours depending on the organization.

Pay: ₹17,910.74 - ₹35,000.00 per month

Work Location: In person

📌 Credentialing Specialist (Keelkattalai)
🏢 Vibrace Technologies
📍 Keelkattalai