Credentialing Executive (Provider Enrollment)

Job Title: Credentialing Executive

Location: Trichy (Remote)

Employment Type: Full-time

Shift: Night Shift (6 PM – 3.30 AM)

We are seeking a detail-oriented Credentialing Specialist with strong experience in provider credentialing, onboarding, and primary source verification. The ideal candidate will be responsible for ensuring that all healthcare providers meet organizational, state, and federal standards while maintaining accurate and up-to-date credentialing records.

Roles and Responsibilities:

• Conduct comprehensive provider credentialing, including collecting, reviewing, and verifying education, training, licensure, certifications, and work history.

• Perform thorough primary source verification (PSV) to validate provider qualifications and credentials.

• Manage the complete provider onboarding process, ensuring timely submission of required documentation.

• Ensure compliance with state, federal, and organizational regulations throughout the credentialing lifecycle.

• Prepare, complete, and submit applications for provider enrollment with insurance networks, Medicare, Medicaid, and for hospital privileges.

• Track application statuses, follow up on pending approvals, and communicate updates to stakeholders.

• Maintain accurate and up-to-date provider profiles in credentialing databases and systems.

• Monitor expiration dates for licenses and certifications, ensuring timely renewals.

• Act as a liaison between providers, insurance networks, regulatory agencies, and internal departments.

• Collaborate with physicians and healthcare staff regarding credentialing requirements and updates.

• Identify and resolve discrepancies or delays in credentialing or enrollment processes.

• Address provider inquiries and investigate complaints related to credentialing and enrollment.

Qualifications and Education Requirements:

• Minimum 1+ year of experience in provider credentialing.

• Graduation in any discipline.

Preferred Skills:

• Strong exposure to provider credentialing, onboarding, and primary source verification.

• Excellent attention to detail and strong organizational skills.

• Experience with credentialing software and databases (e.g., CAQH, PECOS).

• Familiarity with regulatory guidelines such as CMS, NCQA, and the Joint Commission.

• Ability to work independently, prioritize tasks, and meet deadlines.

• Strong communication skills to collaborate effectively with clients and internal billing teams.