About the Role

We are seeking a detail-oriented Credentialing Specialist with 3+ years of experience to join our team. This role is responsible for managing the end-to-end credentialing and re-credentialing process for providers, ensuring compliance with regulatory, payer, and accreditation standards. The ideal candidate has strong organizational skills, a keen eye for detail, and experience navigating credentialing databases and payer enrollment systems.

Key Responsibilities

• Process initial credentialing and re-credentialing applications for physicians, nurse practitioners, and other healthcare providers

• Verify provider credentials, including licenses, education, board certifications, malpractice history, and work history through primary source verification (PSV)

• Maintain accurate and up-to-date provider files in credentialing databases MD-Staff

• Coordinate with payers to complete provider enrollment and ensure timely reimbursement eligibility

• Track expiring licenses, certifications, and insurance to ensure continuous compliance





• Prepare credentialing files for committee review and present findings as needed

• Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal regulations

• Respond to internal and external inquiries regarding provider credentialing status

• Maintain confidentiality of sensitive provider information in accordance with HIPAA

• Identify and resolve discrepancies in credentialing files in a timely manner

• Support audits and provide documentation as requested

Qualifications

• 3+ years of credentialing experience in a healthcare, managed care, or hospital setting

• Bachelor's degree preferred

• Robust knowledge of credentialing standards (NCQA, URAC, CMS) and primary source verification processes

• Experience with credentialing software/databases (CAQH, MD-Staff)

• Familiarity with payer enrollment processes (Medicare, Medicaid, commercial insurers)

• Excellent attention to detail and organizational

📌 Credentialling Specialist (Chennai)
🏢 Acurus Solutions Private
📍 Chennai