Provider Credentialing & Enrollment Specialist
Employment Type: Full-time, Permanent Work Location: Remote (work from home) — candidates must be based in Pune or New Delhi / NCR Schedule: Must work hours that overlap with U.S. business hours (U.S. time-zone support) Experience Required: Minimum 5 years in U.S. healthcare provider credentialing / payer enrollment Compensation: ₹8–10 LPA (based on experience) Language: Fluent written and spoken English (required) Reports To: Practice Administrator / Operations Manager Position Overview We are a U.S.-based medical practice seeking a detail-obsessed Provider Credentialing & Enrollment Specialist to own our end-to-end credentialing and credential-maintenance function across multiple physicians, locations, payers, and entities. This is not a forms-submission role: success is measured by whether every provider is correctly enrolled, active, and billable with every required payer, and whether no license, registration, or credentialing item ever expires unnoticed. You will work remotely from Pune or New Delhi / NCR, on a schedule that overlaps U.S. business hours, communicating directly with our physicians, billing team, payers, and licensing boards. We are looking for someone who follows up relentlessly, catches small data mismatches before they cause denials, and treats credentialing as a revenue-cycle function rather than paperwork.
Key Responsibilities
Manage initial provider enrollment, recredentialing, and revalidation across Medicare (PECOS), Medicaid, and commercial payers. Complete and maintain payer applications, link providers to the correct group / TIN, manage practice locations, effective dates, and provider terminations. Maintain accurate CAQH ProView profiles, attestations, and NPPES / NPI records for all providers. Track and prevent expiration of state medical licenses, DEA registrations, DPS/CDS registrations, board certifications, malpractice coverage, CME, ACLS/BLS, and other expirable documents. Maintain a live credentialing database and tracker capturing status, missing items, follow-up dates, effective dates, revalidation dates, and approval proof for every provider, payer, and location. Follow up with payers every 7–14 days, escalate stalled applications, and confirm that each provider is approved, loaded correctly, and billable under the right entity, TIN, and location. Verify the accuracy of provider demographics — legal name, NPI, TIN, addresses, license numbers, taxonomy, PTAN, and effective dates — to prevent enrollment delays and claim denials. Collect, name consistently, and securely store credentialing documents (CVs, licenses, DEA/DPS, board certs, diplomas, malpractice face sheets, W-9s, IDs, etc.). Communicate clearly and professionally in English with physicians, billing, HR, administrators, payer representatives, licensing boards, and malpractice carriers. Keep the billing team informed of exactly when each provider becomes active and billable with each payer, and flag credentialing risks that affect new-location launches, start dates, and cash flow. Required Qualifications 5+ years of U.S. healthcare provider credentialing or payer enrollment experience. Hands-on experience maintaining physician licenses, DEA registrations, CAQH profiles, malpractice documents, CME records, and payer recredentialing deadlines. Working knowledge of Medicare, Medicaid, and commercial insurance enrollment workflows, including the difference between credentialing, contracting, and being loaded/billable. Proficiency with CAQH ProView, NPPES, PECOS, payer portals, and state licensing board websites; comfortable learning new portals without hand-holding. Strong attention to detail with the ability to identify inconsistencies in provider demographics, TINs, NPIs, addresses, licenses, and payer records. Ability to build and maintain credentialing trackers, expiration dashboards, and payer follow-up logs (Excel, Airtable, Smartsheet, Notion, BambooHR, or credentialing software). Excellent written English and persistent, professional follow-up skills. Ability to manage multiple providers, locations, payers, and deadlines simultaneously and work independently. Fluent spoken and written English, a reliable high-speed internet connection, and a quiet home-office setup. Willing and able to work hours that overlap with U.S. business hours. Based in Pune or New Delhi / NCR. High level of confidentiality and professionalism when handling sensitive provider information.
Preferred Qualifications
Experience credentialing physicians in a multispecialty, nephrology, primary care, hospitalist, or outpatient practice. Experience with Medicare PECOS revalidation and Medicaid enrollment. Experience with commercial payer portals such as Availity, UnitedHealthcare, Optum, Cigna, Aetna, and BCBS. Experience supporting multi-location or multi-entity medical groups. Familiarity with revenue-cycle operations and claim-denial prevention. Certified Provider Credentialing Specialist (CPCS) certification (a plus, not required if experience is strong). Who Thrives in This Role Extremely organized, persistent, and detail-obsessed. Comfortable chasing payers and pushing physicians for missing documents — firm but professional. Not easily frustrated by slow payer responses; knows when and how to escalate. Self-directed, reliable with trackers and databases, and revenue-cycle aware. What Success Looks Like Every provider is enrolled correctly with every required payer. No license, DEA, DPS, CAQH, CME, malpractice, or payer credentialing item expires unnoticed. Billing always knows exactly when each provider is active, billable, and linked to the correct group, TIN, location, and payer.
How to Apply
Submit your resume along with a brief note describing the providers, specialties, payers, and credentialing tools you have worked with. Strong candidates should be able to clearly explain CAQH, PECOS, NPI, TIN, and payer effective dates, and describe their personal system for tracking deadlines and following up with payers. Apply To This Job