Job Description – Credentialing Specialist

Company: Brandflare Business Solutions Pvt. Ltd.
Position: Credentialing Specialist
Department: US Healthcare – Medical Billing & RCM
Location: Bhopal, Madhya Pradesh
Employment Type: Full-Time

Job Overview

We are looking for an experienced and detail-oriented Credentialing Specialist with hands-on experience in US healthcare provider credentialing, enrollment, and insurance network participation processes. The candidate will be responsible for managing end-to-end provider credentialing activities, ensuring accurate documentation, timely submissions, and consistent follow-ups with insurance companies and healthcare networks.

Roles & Responsibilities

- Manage end-to-end credentialing and enrollment processes for US healthcare providers, physicians, and medical practitioners.
- Handle provider enrollment with commercial insurance companies, Medicare, and Medicaid.
- Complete and maintain CAQH profiles, including initial registration, re-attestation, and profile updates.
- Prepare, submit, and follow up on provider credentialing applications with various insurance payers.
- Work on provider enrollment applications for insurance networks such as Aetna, Cigna, UnitedHealthcare, BCBS, Humana, Medicare, and Medicaid.
- Verify provider licenses, NPI, DEA, malpractice insurance, education, board certifications, and other required credentials.
- Coordinate with insurance companies and payer representatives regarding application status, pending documents, and enrollment approvals.
- Maintain accurate records of credentialing applications, submission dates, follow-up activities, and approval statuses.
- Identify and resolve credentialing-related discrepancies, rejections, and application delays.
- Handle provider re-credentialing, demographic updates, and changes in practice locations or affiliations.




- Maintain credentialing trackers and provide regular status reports to management and clients.
- Ensure all credentialing activities are completed within defined turnaround times and compliance requirements.

Required Skills & Qualifications

- Minimum 3–10 years of hands-on experience in US Medical Credentialing and Provider Enrollment.
- Strong knowledge of US healthcare insurance payers and enrollment procedures.
- Practical experience with CAQH ProView, PECOS, NPPES, and payer portals.
- Understanding of Medicare, Medicaid, and commercial insurance credentialing.
- Excellent written and verbal communication skills.
- Strong follow-up, coordination, and problem-solving abilities.
- Good knowledge of MS Excel, Google Sheets, and credentialing trackers.
- Ability to manage multiple provider credentialing cases simultaneously.
- Robust attention to detail and ability to work independently.

Preferred Experience

- Experience working with US-based hospitals, clinics, medical practices, and healthcare providers.
- Knowledge of end-to-end provider enrollment and re-credentialing.
- Experience handling multiple specialties and insurance networks.
- Familiarity with US healthcare compliance and credentialing documentation.

Key Performance Indicators (KPIs)

- Number of credentialing applications successfully processed.
- Application accuracy and error-free submissions.
- Timely follow-ups and turnaround time.
- Number of provider enrollments and approvals.
- Reduction in pending applications and credentialing delays.
- Proper maintenance of credentialing records and trackers.

Working Conditions

- Full-time, work-from-office position.
- US business hours / assigned evening shift.
- Saturday and Sunday weekly off.

Interested candidates can share their updated resumes along with details of their US Credentialing experience.

Pay: ₹30,000.00 - ₹90,000.00 per month

Work Location: In person

📌 Credentialing Specialist (Bhopal)
🏢 Brandflare Business Solutions Pvt Ld
📍 Bhopal