Medical Credentialing & Enrollment Specialists

Job Summary:

We are seeking a detail-oriented and experienced Medical Credentialing & Enrollment Specialist to manage provider credentialing, re-credentialing, and payer enrollment processes. The ideal candidate will ensure compliance with insurance and regulatory requirements while maintaining accurate provider records and timely submissions.

Key Responsibilities:

• Manage end-to-end provider credentialing and enrollment with insurance payers (Medicare, Medicaid, Commercial Plans).
• Prepare and submit initial credentialing and re-credentialing applications.
• Maintain and update provider information in CAQH (Council for Affordable Quality Healthcare).
• Track application status and follow up with payers to ensure timely approvals.
• Handle provider enrollment, revalidation, and demographic updates.
• Maintain accurate records of provider credentials, licenses, certifications, and expirations.
• Coordinate with internal departments (billing, HR, compliance) for required documentation.
• Resolve credentialing-related issues and payer denials.
• Ensure compliance with healthcare regulations and payer requirements.
• Maintain credentialing database and prepare reports as required.

Requirements:

• Bachelor’s degree or relevant experience in Healthcare Administration or related field.
• 1–3+ years of experience in US medical credentialing and enrollment.
• Hands-on experience with CAQH, PECOS, NPPES, and payer portals.
• Strong knowledge of Medicare, Medicaid, and commercial insurance processes.
• Excellent communication and follow-up skills.
• Strong attention to detail and organizational skills.
• Ability to handle multiple providers and deadlines simultaneously.

Preferred Skills:

• Experience in RCM (Revenue Cycle Management) environment.
• Familiarity with credentialing software/tools.
• Knowledge of compliance and healthcare regulations.
• Ability to work independently and in a team environment.

Benefits (Customize as per your company):

• Competitive Salary Package
• Post-Probation & Annual Increments
• Family Health Insurance
• Paid Leaves & Leave Encashment
• Performance & Retention Bonuses
• Meal Allowance
• Pick & Drop (for female staff)

Job Type: Full-time

Work Location: In person