credentialing specialist

Speak Viral

We are looking for a Credentialing Specialist to join our team and oversee administrative tasks dealing with our health facility&rsquo;s credentialing.Credentialing Coordinator responsibilities include maintaining and verifying files and tracking the expiration of certifications throughout the organization.Ultimately, you will work with different departments across our organization to ensure staff members have the necessary accreditations needed throughout the year.Responsibilities<ul><li>Identify discrepancies in information and conduct follow-ups</li><li>Present applications to the facility&rsquo;s Credentialing Committee</li><li>Assist customers with credentialing inquiries</li><li>Respond to health plan provider inquiries</li><li>Capture primary source documentation in computer databases</li><li>Ensure data is backed up</li><li>Follow compliance laws, regulations, procedures, and policies</li></ul>Requirements and skills<ul><li>Proven work experience as a Credentialing Coordinator or similar role</li><li>Excellent verbal and written communication skills</li><li>Expertise with Microsoft Office Word and Excel</li><li>Proficient touch-typing skills</li><li>Ability to focus for extended periods</li><li>Relevant training and/or certifications as a Credentialing Coordinator</li></ul>Benefits: Increment after Probation Annual Increment Free Meal/Tea Career GrowthJob Type: Full-timePay: Rs50,000.00 - Rs100,000.00 per monthApplication Question(s):<ul><li>Will you be able to work in night shift(6pm to 3am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Credentialing Specialist

CrystalVoxx Ltd.

About Company:-CrystalVoxx Ltd, a KPO providing end to end service in Revenue Cycle Management (RCM), Credentialing, Medical Coding, Medical Transcription, Virtual Assistance to doctors / providers in US Healthcare Industry.Job Description:-<ul><li>Location:- Ahmedabad</li><li>Shift:- 5:30 PM to 2:30 AM</li><li>Working Days:- Monday to Friday</li></ul>Roles &amp; Responsibilities:<ul><li>Completes providers credentialing, re-credentialing applications; monitors applications, and follows-up as needed.</li><li>Maintains knowledge of current health plan requirements for credentialing process.</li><li>Tracks license and certification expirations for all providers to ensure timely renewals.</li><li>Ensures practice addresses / Phone number / Fax Number are current with health plans.</li><li>Identifying discrepancies in information and conducting follow-ups.</li><li>Responding to health plan provider inquiries.</li><li>Ensure that facility/providers comply with federal and state regulations regarding licensure.</li><li>Ensure that health-care providers update their certification or licensing on time.</li><li>Create NPPES (National Plan and Provider Enumeration System) and profiles for Medicare and NPI (National Provider Identification)</li><li>Creates and maintains CAQH (Council for Affordable Quality Healthcare) accounts.</li><li>Evaluates and maintains positive working relationships with outside credentialing partners, including health plans, field leadership.</li></ul>Skills required:<ul><li>Minimum 1-2 years credentialing experience is additional.</li><li>Proficient with Windows, MS Office, Outlook, and Internet Explorer</li><li>Excellent time management and organizational skills</li><li>Excellent written and verbal communication skills</li></ul>Job Type: Full-timePay: &#8377;252,000.00 - &#8377;360,000.00 per yearApplication Question(s):<ul><li>What is your current/last CTC?</li><li>What is your notice period?</li><li>What is your expected CTC?</li></ul>Work Location: In person

ebs ameri

<ul><li>Provider Credentialing: Prepare, submit, and maintain credentialing and re-credentialing applications for physicians and other healthcare providers.</li><li>Data Management: Compile and maintain accurate provider data in credentialing databases and systems, such as CAQH, PECOS, and NPPES.</li><li>Verification Processes: Conduct primary source verification of state licenses, DEA certificates, board certifications, and other relevant credentials.</li><li>Enrollment Coordination: Manage the enrollment process with various insurance payers, ensuring timely submission and follow-up to achieve in-network status.</li><li>EDI, ERA, and EFT Enrollment: Initiate and complete Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA), and Electronic Funds Transfer (EFT) enrollments to establish electronic claims submission, remittance processing, and payments from insurance carriers.</li><li>Compliance Monitoring: Stay updated with current regulations, policies, and guidelines related to credentialing and enrollment to ensure organizational compliance.</li><li>Documentation Maintenance: Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs130,000.00 per monthWork Location: In person

Macrise Tech Solutions

Organization: One Behavioral Health &amp; Alara Healthcare Location: Wapda Town, LahoreOne Behavioral Health and Alara Healthcare provide high-quality outpatient and inpatient behavioral health services for adults and children across the Houston area. As our organization grows, we are seeking a highly organized and detail-oriented Credentialing Specialist to ensure provider compliance, support smooth healthcare operations, and maintain high standards of patient care.Role OverviewAs a Credentialing Specialist, you will manage the full lifecycle of provider credentialing and re-credentialing across multiple networks and platforms. Your attention to detail, proactive approach, and follow-through will ensure providers remain compliant with payer, regulatory, and hospital requirements, directly supporting efficient billing, timely authorizations, and quality patient care.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Maintain and update provider credentialing files for commercial and government payers.</li><li>Manage CAQH profiles and ensure compliance with CMS and payer-specific standards.</li><li>Process initial credentialing and re-credentialing applications for Medicare, Medicaid, and private insurers.</li><li>Handle applications and renewals for professional licenses, DEA registration, and controlled substance permits.</li><li>Complete government and regulatory revalidation processes within required timelines.</li><li>Coordinate hospital credentialing, maintain provider privileges, and manage ongoing affiliations.</li></ul>Collaboration &amp; Support<ul><li>Work closely with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials and authorization issues.</li><li>Ensure provider information is accurate across CAQH, PECOS, NPPES, CMS databases, and internal systems.</li><li>Maintain an internal credentialing grid with provider credentials, renewal dates, and login details.</li><li>Provide administrative support for audits, compliance checks, and related documentation as required.</li></ul>Ideal Candidate Profile<ul><li>Strong knowledge of healthcare credentialing standards, payer requirements, and regulatory compliance.</li><li>Excellent organizational skills with meticulous attention to detail and accuracy.</li><li>Experience with credentialing platforms such as CAQH, PECOS, and NPPES.</li><li>Ability to manage multiple tasks independently while collaborating effectively with internal teams.</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Provider Credentialing

Sunbound

<div>About Sunbound
Company. Sunbound is building the &ldquo;financial OS for senior care.&rdquo; The current senior care payments experience is broken&mdash;leading to higher costs, operational inefficiencies for senior living operators, and unnecessary stress for families. Sunbound solves this by delivering the first modern platform to manage this process end-to-end, saving operators and families time, money, and effort.
Mission. Our founders were inspired to start the business after seeing these challenges firsthand with their own families. We deeply care about supporting one of the most underserved groups in our population: seniors. Sunbound&rsquo;s mission is to make managing money for senior living easy&mdash;so our customers can focus on what really matters: providing quality housing and care.
Team. We're a tight-knit, driven team with hubs in NYC and Washington, DC.
Traction. Since launching in mid-2023, we now serve thousands of families and are doing 7 figures in ARR.
Growth. Sunbound is on fire&mdash;growing over 30% month-over-month. The senior living market is a massive and fast-growing $230B+ opportunity as the &ldquo;baby boomer&rdquo; generation continues to age.
Funding. We recently closed our Series A from top-tier investors including TTV Ventures, Fika Ventures, Bling Capital, Liquid2 Ventures, Cambrian Ventures and Max Ventures. These firms have collectively backed over 20 unicorns such as Square, Lyft and Rippling. We also have backing from key industry participants including LiveOak Bank and Omega Healthcare Investors (the largest Skilled Nursing focused REIT).
About the role
Sunbond is looking to add a Credentialing Analyst to their team! This mission critical role will support end-to-end credentialing operations for Sunbound's clients. This role is ideal for someone early in their career who is highly organized, comfortable working in spreadsheets and systems, and excited to learn healthcare credentialing and revenue cycle processes. 
You&rsquo;ll help manage day-to-day credentialing tasks, maintain and improve workflows, and contribute to building new processes as we expand into additional payers and service lines. You&rsquo;ll report to our Revenue Cycle Team Lead and a portfolio of Assisted Living, Memory Care and Skilled Nursing Facility (SNF) clients. Your work will directly support timely licensing, payer enrollment, and uninterrupted revenue for our clients. There is also an opportunity to be a multi-tool player, supporting when necessary other revenue cycle activities such as claims follow-up, cash posting, and reconciliation.
Responsibilities
In this role you will...<ul><li>
Manage the full credentialing lifecycle for new and existing providers under client contracts, ensuring all payer requirements are met for successful enrollment.</li><li>
Complete, track, and maintain Managed Care Organization (MCO) contract applications for Medicaid-credentialed communities and SNFs, as applicable.</li><li>
Support process improvement efforts by identifying workflow gaps and recommending opportunities for automation, new tools, or more efficient steps.</li><li>
Create and update Standard Operating Procedures (SOPs) for new payer contracts and credentialing workflows; help drive consistent implementation across the team.</li><li>
Assist with revenue cycle tasks including claims follow-up, cash posting, reconciliation, and data cleanup as needed.</li><li>
Track credentialing metrics and provide clear reporting on progress, roadblocks, and timelines; suggest ways to make reporting more actionable.</li><li>
Communicate effectively with client contacts and internal teams to share updates, prioritize workloads, and gather needed information.</li></ul>
What we expect from you<ul><li>
Bachelors degree with 0-5 years experience<ul><li>
Prior healthcare credentialing or revenue cycle exposure is helpful, but not required for entry-level candidates&mdash;we will train the right person.</li></ul></li><li>
Strong overall computer and systems aptitude; able to learn new tools quickly and troubleshoot independently</li><li>
You are an Excel wizard - comfortable with formulas, filters, pivot tables, VLOOKUP/XLOOKUP, and cleaning/organizing data</li><li>
Detail-oriented with strong organizational and follow-through skills.</li><li>
Clear written and verbal communication skills, especially when tracking multiple items and stakeholders.</li><li>
Ability to manage deadlines in a fast-paced, client-focused environment.</li><li>
A resilient person with a &ldquo;can do&rdquo; attitude</li><li>
Someone who is determined to win</li></ul>
Bonus Qualifications<ul><li>
Interest in AgeTech / Senior living</li><li>
Experience with workflow automation tools (e.g., macros, Excel automation, RPA, or similar) is a plus</li></ul>
Why join us<ul><li>
Collaborative, mission-driven team that cares deeply about making an impact in senior care and doing right by our customers</li><li>
Product-led culture with a focus on continuous improvement, learning, and transparency</li><li>
Real ownership in building customer-facing functions from the ground up</li><li>
Opportunity to shape the future of the business and grow with us as we scale</li></ul>
Equal opportunity employment
We are an equal opportunity employer. We welcome amazing people from all backgrounds, experiences, abilities, and perspectives. If you need a reasonable accommodation during the application process, email us at apply@sunboundhomes.com. We hope you&rsquo;ll join us.
Compensation Range: $60K - $75K</div>

Credentialing Analyst

The Credentialing Executive is responsible for managing the provider enrollment and credentialing process with insurance companies, hospitals, and other healthcare organizations. This role ensures all providers are properly credentialed and enrolled to receive timely reimbursement for medical services, maintaining compliance with payer and regulatory requirements.Key Responsibilities:&middot; Prepare, review, and submit credentialing and re-credentialing applications for healthcare providers with commercial and government insurance payers (e.g., Medicare, Medicaid, BCBS, Aetna, UnitedHealthcare, Cigna, etc.).&middot; Maintain up-to-date records of providers in credentialing databases and online systems.&middot; Track the status of credentialing and enrollment applications, follow up with payers, and resolve any discrepancies or issues.&middot; Verify provider credentials, including licenses, board certifications, DEA, malpractice insurance, and other necessary documents.&middot; Coordinate with internal billing teams to ensure providers are properly linked and active with payers before billing.&middot; Update and maintain CAQH profiles, NPI registrations, and PECOS enrollments.&middot; Manage expirables (licenses, insurance, certifications) and notify providers of renewals.&middot; Ensure compliance with federal, state, and payer-specific regulations.&middot; Generate and maintain credentialing reports and dashboards.&middot; Communicate professionally with providers, practice managers, and insurance representatives.Required Qualifications:&middot; Bachelor&rsquo;s degree in Healthcare Administration, Business, or a related field (or equivalent work experience).&middot; 1&ndash;3 years of experience in medical credentialing, provider enrollment, or medical billing.&middot; Knowledge of CAQH, NPPES, PECOS, and payer portals.&middot; Strong understanding of commercial and government payer processes.&middot; Excellent communication and organizational skills.&middot; Proficiency in MS Office (Excel, Word, Outlook) and credentialing software.&middot; Ability to handle multiple tasks, prioritize, and meet deadlines.Preferred Qualifications:&middot; Experience with US-based healthcare systems or RCM/BPO companies.&middot; Certification in credentialing (e.g., CPCS, CPMSM) is a plus.&middot; Knowledge of medical billing and compliance regulations (HIPAA, CMS).Key Competencies:&middot; Attention to detail and accuracy&middot; Strong problem-solving and analytical skills&middot; Professional communication and interpersonal skills&middot; Time management and ability to work independently&middot; Team collaborationJob Type: Full-timePay: Rs30,000.00 - Rs50,000.00 per monthApplication Question(s):<ul><li>Will you be able to work in night shift(6pm to 3am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Credentialing Executive

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