AR / Credentialing specialist

We are seeking a detail-oriented Provider Credentialing and Enrollment Specialist to manage the credentialing and enrollment processes for healthcare providers, including physicians, nurse practitioners, and physician assistants. This role involves handling initial credentialing, recredentialing, and enrollment with various insurance payers, maintaining accurate provider and practice information, and ensuring compliance with regulatory requirements. The ideal candidate will work closely with multiple internal teams to support billing readiness and resolve enrollment-related issues efficiently.

Key Responsibilities

- Manage initial credentialing and recredentialing for physicians, DOs, MDs, NPs, PAs, and other eligible healthcare professionals.
- Complete and maintain applications through CAQH ProView, PECOS, NPPES, and payer-specific portals.
- Handle enrollment with commercial insurance payers, Medicare, Medicaid, and other government or regional health plans.
- Submit provider enrollment applications for new providers and newly established practice locations.
- Track application progress, effective dates, approval letters, and pending requirements.
- Follow up with insurance companies to resolve delayed, rejected, or incomplete applications.
- Enroll group practices and healthcare organizations under the appropriate Tax Identification Number (TIN) and organizational NPI.
- Link individual rendering providers to the correct billing groups, practice locations, and payer contracts.
- Maintain accurate provider demographic, ownership, tax, address, and banking information.
- Coordinate updates for new locations, provider departures, practice acquisitions, and changes in ownership or legal structure.
- Verify payer participation status and effective dates prior to billing claims.
- Maintain complete and up-to-date credentialing files, including state medical licenses, DEA registrations, board certifications, malpractice insurance, and other required documents.
- Monitor license expirations, recredentialing deadlines, CAQH attestation dates, and payer enrollment renewals.
- Protect confidential provider information in compliance with HIPAA and company security policies.
- Contact insurance payer enrollment departments to check application status and resolve outstanding requirements.
- Investigate credentialing-related claim denials and coordinate with Accounts Receivable, billing, and denial management teams to resolve payment delays.
- Escalate complex cases to management as needed.
- Maintain detailed records of communications, portal updates, and payer correspondence.
- Collaborate with Revenue Cycle Management and Operations teams to support new client onboarding and ensure payer enrollment readiness.
- Identify credentialing gaps that could impact claim submission and reimbursement.
- Develop and maintain standard operating procedures (SOPs) and credentialing checklists.
- Prepare daily, weekly, and monthly credentialing status reports and maintain master trackers.
- Provide management with actionable recommendations to improve credentialing efficiency.

Required Qualifications

- Bachelor’s degree preferred.
- Minimum 3–5 years of experience in U.S. medical credentialing and provider enrollment.
- Strong experience with CAQH ProView, PECOS, NPPES, and commercial payer portals.
- Practical knowledge of Medicare, Medicaid, and commercial insurance enrollment processes.
- Experience enrolling individual providers and group practices under appropriate TIN and NPI.
- Familiarity with provider recredentialing, demographic updates, location additions, and group affiliations.
- Proven ability to coordinate with U.S. insurance payers via phone and online portals.
- Excellent written communication, documentation, and follow-up skills.
- Proficiency in Microsoft Excel, Google Sheets, and credentialing trackers.

Preferred Qualifications and Benefits

- Experience supporting urgent care, primary care, and multi-location medical practices.
- Knowledge of state-specific enrollment requirements, particularly Michigan and Illinois.
- Familiarity with AdvancedMD or other EHR/practice management systems.
- Understanding of payer contracts, participation effective dates, and credentialing-related denial management.
- Experience establishing or improving credentialing departments.
- Ability to train junior staff and develop SOPs.
- Competitive monthly salary ranging from Rs100,000 to Rs130,000.
- Work location is in person.

This position offers the opportunity to play a critical role in ensuring providers are properly credentialed and enrolled, facilitating smooth billing operations and timely reimbursements. If you have a strong background in medical credentialing and enjoy working in a collaborative environment, we encourage you to apply.