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Manage end-to-end credentialing and re-credentialing for providers, verify credentials via primary source verification, maintain provider records in MD-Staff, coordinate payer enrollment, track expirations, prepare committee files, ensure compliance with NCQA/URAC/CMS/Joint Commission/HIPAA, respond to inquiries, resolve discrepancies, and support audits.
About the Role
We are seeking a detail-oriented Credentialing Specialist with 3+ years of experience to join our team. This role is responsible for managing the end-to-end credentialing and re-credentialing process for providers, ensuring compliance with regulatory, payer, and accreditation standards. The ideal candidate has strong organizational skills, a keen eye for detail, and experience navigating credentialing databases and payer enrollment systems.
Key Responsibilities
- Process initial credentialing and re-credentialing applications for physicians, nurse practitioners, and other healthcare providers
- Verify provider credentials, including licenses, education, board certifications, malpractice history, and work history through primary source verification (PSV)
- Maintain accurate and up-to-date provider files in credentialing databases MD-Staff
- Coordinate with payers to complete provider enrollment and ensure timely reimbursement eligibility
- Track expiring licenses, certifications, and insurance to ensure continuous compliance
- Prepare credentialing files for committee review and present findings as needed
- Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal regulations
- Respond to internal and external inquiries regarding provider credentialing status
- Maintain confidentiality of sensitive provider information in accordance with HIPAA
- Identify and resolve discrepancies in credentialing files in a timely manner
- Support audits and provide documentation as requested
Qualifications
- 3+ years of credentialing experience in a healthcare, managed care, or hospital setting
- Bachelor's degree preferred
- Strong knowledge of credentialing standards (NCQA, URAC, CMS) and primary source verification processes
- Experience with credentialing software/databases (CAQH, MD-Staff)
- Familiarity with payer enrollment processes (Medicare, Medicaid, commercial insurers)
- Excellent attention to detail and organizational skills
- Strong written and verbal communication skills
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment
- Proficiency in Microsoft Office (Excel, Word, Outlook)
Preferred Skills
- Experience with delegated credentialing audits
- Knowledge of state-specific licensing requirements
- Prior experience supporting medical staff committees or credentialing committees
Acurus Chennai, Tamil Nadu, IND Office
Chennai, India
Acurus Chennai, Tamil Nadu, IND Office
6 & 7, Mayor Sivaraj Street, Royapettah, ,, Chennai, Tamil Nadu, India, 600 014
What you need to know about the Chennai Tech Scene
To locals, it's no secret that South India is leading the charge in big data infrastructure. While the environmental impact of data centers has long been a concern, emerging hubs like Chennai are favored by companies seeking ready access to renewable energy resources, which provide more sustainable and cost-effective solutions. As a result, Chennai, along with neighboring Bengaluru and Hyderabad, is poised for significant growth, with a projected 65 percent increase in data center capacity over the next decade.
