About the Role

We're looking for a detail-oriented Credentialing Specialist to manage end-to-end provider credentialing and payer enrollment for U.S. healthcare clients. You'll be the go-to person for keeping providers compliant, enrolled, and revenue-ready across Medicare, Medicaid, and commercial payers.

What You'll Do

- Manage end-to-end provider credentialing, payer enrollment, and recredentialing
- Complete and submit applications to Medicare, Medicaid, Medicare Advantage, and commercial payers
- Maintain provider data in CAQH, NPPES/NPI, PECOS, and various payer portals
- Verify licenses, DEA registration, board certifications, malpractice insurance, and other credentials
- Track credential and license expiration dates and coordinate timely renewals
- Perform or coordinate primary source verification as required
- Monitor applications, payer follow-ups, approvals, effective dates, and outstanding requirements
- Process provider additions, terminations, demographic changes, group affiliations, and location updates
- Stay current on CMS, state, Medicaid, and payer-specific requirements
- Partner with Billing, AR, Denials, Provider Relations, and Operations teams to resolve credentialing issues




- Investigate and support resolution of credentialing-related claim denials
- Maintain accurate, confidential, audit-ready credentialing records
- Prepare status reports and escalate delayed or complex payer issues

What You Bring

- 1–2 years of experience in U.S. healthcare credentialing, provider enrollment, medical billing, or RCM
- Hands-on experience with CAQH, NPI/NPPES, PECOS, and Medicare/Medicaid/commercial payer processes
- Strong understanding of U.S. payer enrollment and credentialing workflows
- Excellent attention to detail, organizational skills, and follow-through
- Ability to juggle multiple providers, payers, and deadlines simultaneously
- Robust written and verbal communication skills
- Proficiency in Microsoft Office, especially Excel
- Prior experience in a U.S.-based RCM or medical billing company

Nice to Have

- Multi-state provider enrollment experience
- Familiarity with payer portals such as Availity
- Knowledge of Medicare/Medicaid revalidation and payer recredentialing processes
- CPCS, CPMSM, or related credentialing certification

Work Location: In person

📌 Credentialing Specialist – U.S. Healthcare RCM (India)
🏢 Cojective Labs
📍 India