Key Responsibilities

Credentialing & Enrollment

- Manage end-to-end credentialing and re-credentialing for healthcare providers (physicians, APPs, facilities).
- Prepare, submit, and track provider enrollment applications with commercial payers, Medicare, Medicaid, and managed care organizations.
- Ensure accuracy and completeness of credentialing documents including licenses, DEA, board certification, malpractice insurance, and education history.
- Maintain provider records in credentialing databases and CAQH.

Compliance & Quality

- Ensure compliance with NCQA, CMS, Joint Commission, state regulations, and payer requirements.
- Conduct primary source verifications and maintain audit-ready files.
- Monitor credentialing expiration dates and proactively initiate re-credentialing.
- Support internal and external audits and implement corrective actions when needed.

Provider & Payer Coordination

- Serve as the primary point of contact for providers, payers, and internal stakeholders regarding credentialing status.
- Resolve credentialing issues, delays, and denials by coordinating with insurance representatives.




- Communicate credentialing updates clearly and professionally to providers and leadership.

Leadership & Process Improvement

- Guide and mentor junior credentialing specialists.
- Assist in developing credentialing SOPs, checklists, and best practices.
- Identify process gaps and recommend improvements to enhance efficiency and turnaround time.
- Generate credentialing reports and metrics for management review.

Required Qualifications

- Bachelor’s degree in Healthcare Administration, Business, or a related field (preferred).
- 4–6+ years of healthcare credentialing and provider enrollment experience.
- Robust knowledge of payer enrollment processes (Medicare, Medicaid, commercial plans).
- Hands-on experience with CAQH, NPPES, PECOS, and credentialing software.
- Excellent attention to detail and organizational skills.
- Ability to manage multiple providers and deadlines simultaneously.
- Strong written and verbal communication skills.

Interested candidates, kindly share resume at [email protected] Pay: ₹45,000.00 - ₹60,000.00 per month

Benefits

- Provident Fund

Work Location: In person

📌 Senior Credentialing Specialist (Sahibzada Ajit Singh Nagar)
🏢 3D Solutions
📍 Sahibzada Ajit Singh Nagar