Job Description

Job Summary:

The

RCM Credentialing Specialist

is responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers. This role ensures that all providers are properly enrolled with insurance payers and remain compliant with regulatory and contractual requirements. The specialist will work closely with providers, insurance companies, and internal RCM and compliance teams to maintain accurate and up-to-date credentials.

Key Responsibilities:

Prepare and submit provider applications for credentialing and enrollment with insurance payers (Medicare, Medicaid, commercial). Track and manage the status of all applications, re-credentialing, and re-validation efforts. Maintain accurate and up-to-date records in credentialing databases and software systems. Follow up with payers and providers to ensure timely completion of the credentialing process. Monitor expiring credentials and initiate re-credentialing processes ahead of deadlines. Ensure compliance with NCQA, CMS, and other regulatory bodies. Communicate effectively with providers and internal departments regarding credentialing updates and requirements. Resolve issues or discrepancies in credentialing applications or documents. Coordinate with billing teams to ensure provider enrollment status aligns with billing eligibility. Assist in audits and reporting related to provider credentialing.

Qualifications:

Education:

High school diploma or GED required. Associate or Bachelor's degree in healthcare administration or related field preferred.

Experience:

Minimum 2 years of experience in medical credentialing, provider enrollment, or healthcare administration.

Knowledge:

Understanding of payer credentialing and enrollment processes (Medicare, Medicaid, and commercial plans). Familiarity with CAQH, PECOS, NPPES, and other credentialing databases. Working knowledge of RCM workflows is a plus.

Skills:

Strong organizational and time management skills. Excellent written and verbal communication. Proficiency in Microsoft Office Suite and credentialing software (e.g., Modio, CredentialStream, etc.). Detail-oriented with the ability to manage multiple deadlines.

Contact Information:

Interested Candidates Can Reach Out At:

Phone:

+91 96008 86888

Email:

hrtp@acidusms.com

Job Type: Full-time

Pay: ₹15,000.00 - ₹25,000.00 per month

Benefits:

Provident Fund
Work Location: In person