Credentialing Executive/Specialist

CareGenix is seeking a skilled Credentialing Executive/Specialist to join our team and oversee provider credentialing, licensing, payer enrollment, and contracting activities for healthcare providers and practices based in the United States. This role requires managing multiple credentialing processes to ensure compliance and timely approvals, supporting the smooth operation of provider networks. The position operates on a shift from 6:30 PM to 3:30 AM and is based at our office located in Cherry's Plaza, Defence Phase 2 Extension.

Key Responsibilities
- Manage the credentialing and recredentialing processes for providers and practices.
- Coordinate state licensing applications, renewals, and ensure ongoing compliance with regulatory requirements.
- Handle enrollments with both commercial and government payers across the U.S. healthcare system.
- Maintain accurate and up-to-date provider information in CAQH, PECOS, NPPES, and various payer portals.
- Assist with payer contracts, including fee schedules and participation agreements.
- Address and resolve issues related to closed panels and network participation.
- Follow up consistently with payers and regulatory bodies to secure timely approvals.
- Monitor all credentialing, licensing, and enrollment deadlines to prevent lapses that could affect provider participation.

Required Qualifications
- A minimum of 5 years of experience in credentialing, licensing, payer enrollment, and contracting within the healthcare industry.
- Strong knowledge of major payers such as Medicare, Medicaid, BCBS, UnitedHealthcare, Aetna, Cigna, and Humana.
- Proven hands-on experience with contract negotiations and managing panel closure challenges.
- Proficiency in using credentialing and enrollment systems including CAQH, PECOS, NPPES, and various payer portals.
- Excellent communication skills, with strong organizational, analytical, and problem-solving abilities.

The role offers a competitive monthly salary ranging from Rs80,000 to Rs250,000, commensurate with experience and qualifications. This is an in-person position requiring attendance at the specified office location.

Applicants will be asked to describe their experience with U.S. healthcare credentialing, including the types of providers they have credentialed, the payers they have worked with, and the credentialing systems or portals they have utilized regularly, such as CAQH, PECOS, NPPES, or payer portals. This information will help assess the candidate’s fit for the role.

CareGenix values professionalism and expertise in managing complex credentialing processes and offers an opportunity to contribute to a dynamic healthcare environment.