Job Summary The Credentialing Specialist is responsible for managing the end-to-end provider credentialing and enrollment process with insurance payers. The role ensures that healthcare providers are properly credentialed, enrolled, and re-credentialed to maintain uninterrupted revenue flow and compliance with payer and regulatory requirements.

Key Responsibilities
1. Provider Enrollment & Credentialing
- Handle end-to-end credentialing process for physicians and healthcare providers.
- Prepare and submit provider enrollment applications to insurance payers.
- Complete CAQH registration, updates, and attestations.
- Ensure timely submission of recent enrollments, re-credentialing, and updates. 2. Follow-ups & Payer Communication
- Communicate with insurance companies to track application status.
- Follow up on pending, rejected, or incomplete applications.
- Resolve enrollment-related issues with payers. 3. Documentation & Compliance
- Collect and verify provider documents (licenses, DEA, board certification, malpractice insurance, NPI, etc.).
- Maintain accurate and updated provider records.




- Ensure compliance with payer and regulatory guidelines. 4. Re-Credentialing & Maintenance
- Track re-credentialing timelines and renewal dates.
- Maintain a credentialing database and monitoring system.
- Ensure no lapse in provider participation with payers. 5. Reporting & Coordination
- Maintain credentialing trackers and MIS reports.
- Coordinate with billing, AR, and operations teams for smooth provider activation.
- Support audits related to credentialing documentation. Required Qualifications
- 1-3+ years of experience in provider credentialing (US Healthcare preferred).
- Strong knowledge of CAQH, NPI, PECOS, and insurance payer portals.
- Familiarity with Medicare, Medicaid, and commercial payer enrollment.
- Good communication and follow-up skills.
- Attention to detail and ability to meet deadlines. Preferred Skills
- Experience in RCM / Medical Billing company.
- Knowledge of HIPAA compliance.
- Ability to manage multiple providers simultaneously.
- Strong organizational and documentation skills.

📌 Credentialing Specialist (India)
🏢 Sunshine Pediatric And Family Clinic Private
📍 India