Credentialing Specialist

Job Description

Job Title: Credentialing Executive – Medical Billing Location: [Hyderabad] Job Type: [Full-time] Reports To: Manager Job Summary: The Credentialing Executive is responsible for overseeing and executing the provider credentialing and enrollment process with insurance payers to ensure that all healthcare professionals are properly credentialed and enrolled for reimbursement. This role is critical in preventing claim rejections, delays in payments, and maintaining overall billing compliance. Key Responsibilities: 1. Handle end-to-end provider credentialing and payer enrollment for new and existing healthcare providers. 2. Prepare and submit credentialing applications to government and commercial insurance payers, including Medicare, Medicaid, and private insurers. 3. Monitor and track the status of applications, follow up with payers, and ensure timely approvals. 4. Maintain accurate and up-to-date records of provider credentials, including licenses, board certifications, malpractice insurance, DEA registration, and other required documentation. 5. Update and manage provider profiles in credentialing databases and portals such as CAQH, PECOS, NPPES, and insurance payer websites. 6. Work closely with the medical billing team to ensure all credentialing information is correctly reflected in billing systems to prevent denials or payment issues. 7. Renew and re-credential providers as required by payers and regulatory agencies. 8. Identify and resolve credentialing-related issues and discrepancies that could affect billing and reimbursement. 9. Ensure compliance with all regulatory standards including NCQA, CMS, and payer-specific credentialing requirements. 10. Support audits by providing credentialing documentation and reports when requested. Required Qualifications: -High school diploma or equivalent; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred. -Minimum of 2–3 years of experience in provider credentialing and payer enrollment in a medical billing or RCM (Revenue Cycle Management) environment. -Strong knowledge of payer requirements and credentialing processes for Medicare, Medicaid, and commercial payers. -Proficiency with credentialing software and systems (e.g., CAQH, PECOS, NPPES, Availity). -Familiarity with billing systems and medical billing workflow (e.g., claim submissions, denials related to credentialing). -Strong attention to detail and organizational skills. -Excellent written and verbal communication skills. -Preferred Skills and Certifications: -Certified Provider Credentialing Specialist (CPCS) or Certified Medical Reimbursement Specialist (CMRS) – preferred but not required. -Experience with credentialing in a multi-provider or multi-specialty environment. -Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Job Types: Full-time, Permanent Pay: ₹30,000.00 - ₹35,000.00 per month Benefits: Flexible schedule Health insurance Leave encashment Life insurance Paid sick time Paid time off Schedule: Evening shift Fixed shift Monday to Friday Night shift US shift Supplemental Pay: Overtime pay Performance bonus Work Location: In person