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
Robust 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 Ahmedabad (India)
🏢 Cojective Labs
📍 India