Job Title: Credentialing Specialist – U.S. Healthcare
Job Type: Full-Time | Permanent Work From Home | Remote Opportunity
Shift Timing: U.S. Night Shift – 6:30 PM to 3:30 AM (IST)
Location Requirement: Candidates must be based in Pune only
Joining: Immediate Joiners Preferred
Communication: Must have excellent written and verbal communication skills

Position Overview:

The Credentialing Specialist is responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers contracted with MHS (Mental Health System / Behavior Health Services), IHCP (Indiana Health Coverage Programs), Medicaid, Medicare, and commercial payers. The role requires strict compliance with regulatory guidelines ensuring timely provider onboarding and reducing claim denials. This role involves daily coordination with healthcare providers, payer representatives, and internal teams to maintain accurate credentialing records.

Key Responsibilities:

Application Processing: Collect, evaluate, and process initial and re-credentialing applications while ensuring completeness and accuracy.
Payer Enrollment: Submit and track enrollment applications with IHCP Indiana Medicaid, MHS, Medicare PECOS, and commercial payers, resolving discrepancies to avoid delays and claim denials.
Compliance & Audits: Ensure adherence to NCQA and regulatory standards. Prepare and present credentialing files for internal committee review and external audits.
Communication & Coordination: Communicate with providers, internal teams, and payer agencies to resolve credentialing and enrollment inquiries efficiently.
Expiration Tracking: Manage renewals of licenses, DEA, malpractice, and board certifications with proactive reminders.
Issue Resolution: Investigate and resolve credentialing-related errors impacting reimbursement or onboarding timelines.

Required Qualification:

Bachelor’s degree preferred / equivalent experience in healthcare administration.
Minimum 3 years of experience in provider credentialing or payer enrollment within US healthcare.
Experience handling IHCP (Indiana Health Coverage Programs) credentialing and enrollment is strongly preferred.
Strong understanding of regulatory and accreditation standards.
Strong MS Office skills (Excel reporting, trackers, dashboards).

Key Competencies:

Strong attention to detail and documentation accuracy.
Excellent communication, coordination & follow-up skills.
Strong problem-solving and analytical thinking.
Ability to manage multiple priorities under deadlines.
Customer service and collaborative work approach.
Process ownership and accountability.