Description
Responsibilities
• Manage end-to-end provider and facility credentialing and recredentialing processes for assigned client accounts.
• Prepare, submit, track, and maintain payer enrollment and participation applications for Medicare, Medicaid, and all major commercial payers.
• Verify provider and facility credentials, including state licenses, NPI, DEA, malpractice coverage, CAQH profiles, board certifications, accreditations,and other required documentation.
• Maintain accurate, organized, and audit-ready credentialing records within internal databases, payer portals, and client systems.
• Monitor application status and perform timely follow-ups with payers to ensure prompt approvals and minimize enrollment delays.
• Communicate effectively with providers, facilities, payers, and internal stakeholders to resolve credentialing and enrollment issues.
• Proactively monitor upcoming expirations and initiate renewals to ensure uninterrupted provider and facility participation in payer networks.
• Collaborate with Contracting, Revenue Cycle Management (RCM),



and Billing teams to align credentialing activities with payer contracts and claim submission readiness.
• Prepare and share regular credentialing and enrollment status reports with clients, providing accurate updates on pending, approved, and outstanding items.
• Stay current with CMS regulations, Medicare and Medicaid guidelines, NCQA standards, and commercial payer credentialing requirements to ensure compliance.

Requirements
Qualifications
• Associate's or Bachelor's degree preferred, preferably in Healthcare Administration, Business Administration, or a related field.
• Minimum 2 years of provider credentialing and payer enrollment experience, preferably within an RCM vendor, healthcare organization, or multi-client setting.
• Robust knowledge of Medicare, Medicaid, and commercial payer credentialing and enrollment processes.
• Hands-on experience with PECOS, CAQH, NPPES, payer portals, and cre

📌 Credentialing Specialist, Contracts Hyderabad
🏢 Nimble Solutions
📍 Hyderabad