PROVIDER CREDENTAILING EXECUTIVE

Job Title: Provider Credentialing Executive

Department: Healthcare Operations / Provider Enrollment / RCM
Industry: Healthcare / US Healthcare
Location: ALL OVER INDIA
Experience:  Experienced
Qualification: Graduate (Any stream) – Healthcare background preferred

Job Purpose

The Provider Credentialing Executive is responsible for enrolling healthcare providers (doctors, hospitals, clinics) with insurance payers and maintaining accurate credentialing records to ensure timely reimbursements.

Key Responsibilities

• Handle end-to-end provider credentialing and enrollment processes
• Enroll providers with commercial payers, Medicare, Medicaid, and other insurance networks
• Prepare, review, and submit credentialing applications accurately
• Maintain provider data in CAQH and other credentialing portals
• Track application status and follow up with insurance companies
• Ensure compliance with payer and regulatory requirements
• Maintain credentialing files, documents, and renewal timelines
• Coordinate with providers, internal teams, and payers
• Update provider demographics and re-credentialing information
• Prepare reports and maintain MIS as required

Skills & Competencies

• Good verbal and written communication skills
• Knowledge of provider enrollment and credentialing process
• Familiarity with CAQH, NPI, PECOS, Medicare & Medicaid (preferred)
• Strong attention to detail and documentation accuracy
• Basic computer knowledge (MS Excel, Email, Healthcare portals)

Preferred Candidate Profile

• Experience in US Healthcare / Provider Credentialing / RCM preferred
• Freshers with healthcare process knowledge can apply
• Ability to work under deadlines and handle multiple providers

Employment Type

Full-time / Contract

Salary & Benefits

• Competitive salary (as per experience)
• Performance incentives
• Training on US healthcare processes
• Career growth in healthcare operations