Credentialing Specialist – U.S. Healthcare

Job Title : Credentialing Specialist – U.S. Healthcare

Job Type : Full-Time | Permanent Work From Home | Remote Opportunity

Shift Timing : U.S. Night Shift – 6 : 30 PM to 3 : 30 AM (IST)

Location Requirement : Candidates must be based in Pune only

Joining : Immediate Joiners Preferred

Communication : Must have excellent written and verbal communication skills

Position Overview :

The Credentialing Specialist is responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers contracted with MHS (Mental Health System / Behavior Health Services), IHCP (Indiana Health Coverage Programs), Medicaid, Medicare, and commercial payers. The role requires strict compliance with regulatory guidelines ensuring timely provider onboarding and reducing claim denials. This role involves daily coordination with healthcare providers, payer representatives, and internal teams to maintain accurate credentialing records.

Key Responsibilities :

• Application Processing : Collect, evaluate, and process initial and re-credentialing applications while ensuring completeness and accuracy.
• Payer Enrollment : Submit and track enrollment applications with IHCP Indiana Medicaid, MHS, Medicare PECOS, and commercial payers , resolving discrepancies to avoid delays and claim denials.
• Compliance & Audits : Ensure adherence to NCQA and regulatory standards. Prepare and present credentialing files for internal committee review and external audits.
• Communication & Coordination : Communicate with providers, internal teams, and payer agencies to resolve credentialing and enrollment inquiries efficiently.
• Expiration Tracking : Manage renewals of licenses, DEA, malpractice, and board certifications with proactive reminders.
• Issue Resolution : Investigate and resolve credentialing-related errors impacting reimbursement or onboarding timelines.

Required Qualification :

Key Competencies :

To Apply :

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Note : Candidates must apply only through LinkedIn or email by sending their updated resume.

Resumes sent via WhatsApp will not be accepted or entertained under any circumstances.