Job Description

The Credentialing Specialist verifies healthcare providers' qualifications, licenses, and certifications to enable timely payer enrollment and billing. This role supports our medical billing services by managing credentialing processes for US clients, ensuring regulatory compliance like NCQA and CMS standards. The position works in US Time Zone.

Key Responsibilities:

Collect, review, and verify provider credentials including licenses, education, certifications, and malpractice history through primary source verification. Maintain accurate records in credentialing systems like CAQH or VerityStream, track renewals, and follow up on missing documents. Submit applications to payers, monitor enrollment status, and prepare files for committee reviews and audits. Ensure compliance with healthcare regulations (e.g., JCAHO, CMS) and communicate updates to providers and internal teams. Conduct background checks and support recredentialing processes to minimize billing delays.

Qualifications/Skills:

1. Associate's or Bachelor's degree in healthcare administration, business, or related field; high school diploma with equivalent experience considered.

2. 1-3 years in healthcare credentialing, medical billing, or BPO; certification like CPCS preferred.

3. Strong attention to detail, organizational skills, and knowledge of US healthcare regulations.

4. Proficiency in MS Office, credentialing software, and communication across time zones.

Job Types: Full-time, Permanent

Pay: ?25,000.00 - ?50,000.00 per month

Benefits:

Provident Fund
Work Location: In person