Credentialing Specialist

Job Title : Credentialing Specialist Experience : 1–5 Years Location : Hinjewadi, Pune Salary : Up to 6 LPA

Company Overview :

We are a growing organization committed to delivering high-quality healthcare solutions. As part of our continued expansion, we are looking for a diligent and detail-oriented Credentialing Specialist to join our team in Hinjewadi, Pune. This role is critical in ensuring compliance with credentialing standards and maintaining a strong provider network.

Key Responsibilities :

Manage and maintain up-to-date records of healthcare providers’ credentials, licenses, certifications, and affiliations.

Coordinate and process initial credentialing and re-credentialing applications for providers in accordance with company policies and regulatory standards.

Conduct thorough verification of education, training, experience, and licensure through primary sources.

Liaise with insurance companies, hospitals, and credentialing bodies to ensure timely approvals.

Monitor and track expiration dates for licenses and certifications and proactively follow up for renewals.

Maintain accurate and organized electronic and physical credentialing files.

Ensure compliance with NCQA, URAC, and other regulatory requirements.

Prepare and submit credentialing reports for audits and internal use.

Qualifications & Skills :

Bachelor’s degree in any discipline (Healthcare / Administration preferred).

1 to 5 years of experience in credentialing or healthcare administration.

Strong understanding of credentialing standards, healthcare regulations, and compliance.

Excellent communication and organizational skills.

High attention to detail and ability to manage multiple tasks simultaneously.

Proficiency in MS Office (Excel, Word, Outlook) and credentialing software / tools is an added advantage.

What We Offer :

Competitive salary up to 6 LPA based on experience and skillset.

Opportunity to work in a dynamic and growth-oriented environment.

Supportive team culture and ongoing professional development.