Credential Specialist

A Credential Specialist, often called a Credentialing Specialist, is responsible for managing and verifying the qualifications, licensure, certifications, work history, and compliance of healthcare providers or professionals within an organization. Their primary role is to ensure that all practitioners meet required legal, regulatory, and organizational standards to provide safe and compliant care. This involves collecting and validating documents, maintaining credentialing records, submitting applications for credentialing or re-credentialing with insurance companies or hospitals, and ensuring timely renewal of licenses. They also liaise with regulatory agencies, prepare files for audits or credentialing committees, and communicate with providers to resolve any credentialing issues.

Core Responsibilities

• Collect, verify, and process documentation related to licensure, certifications, education, work experience, and malpractice coverage.
• Maintain and update credentialing records in specialized databases and platforms such as CAQH or Verity Stream.
• Submit and track applications for initial credentialing and re-credentialing with payers and hospital systems.
• Monitor expiration dates for licenses and initiate renewal processes.
• Ensure compliance with regulatory standards from bodies like JCAHO, NCQA, and CMS.
• Prepare and organize documentation for credentialing committee reviews and audits.
• Communicate professionally with healthcare providers, internal staff, and external regulatory agencies.
• Support audit readiness and address requests from payers or compliance bodies.

Job Types: Full-time, Permanent, Fresher

Pay: ₹17,052.86 - ₹51,131.84 per month

Benefits:

• Health insurance
• Provident Fund

Work Location: In person