Credentialing /Enrollment Specialist

Job Summary:

We are seeking a detail-oriented and organized Credentialing & Enrollment Specialist with experience in EDI (Electronic Data Interchange), ERI (Electronic Remittance Inquiry), and EFI (Electronic File Interchange). The specialist will manage provider credentialing, payer enrollment, and data exchange processes to ensure efficient onboarding and compliance with payer requirements.

Key Responsibilities:

• Credentialing & Enrollment
• Collect, verify, and process provider documentation for credentialing and re-credentialing.
• Submit and track enrollment applications with commercial and government payers (e.g., Medicare, Medicaid).
• Maintain provider CAQH profiles and ensure accurate, up-to-date data across all platforms.
• Monitor expirations and proactively manage re-credentialing timelines.
• EDI, ERI, EFI Management
• Handle EDI file submissions for provider enrollment and updates.
• Facilitate ERI processes to ensure timely remittance advices and reporting.
• Manage EFI transactions for bulk submissions to CMS and other entities.
• Collaborate with IT or clearinghouse partners to troubleshoot file transmission errors.
• Compliance & Data Management
• Ensure compliance with payer-specific and federal guidelines.
• Maintain accurate and complete documentation in credentialing databases (e.g., Availity, PECOS, CAQH).
• Prepare reports on credentialing/enrollment statuses and follow up with payers as needed.
• Communication & Support
• Liaise with internal teams (billing, HR, operations) and external entities (payers, clearinghouses).
• Support providers through onboarding, credentialing, and change requests.
• Provide education on enrollment processes and documentation requirements.

Qualifications:

• Education: Associate’s or Bachelor’s degree preferred; equivalent work experience accepted.
• Experience: 2–4 years in healthcare credentialing and payer enrollment; EDI/EFI/ERI experience required.
• Skills:
• Knowledge of PECOS, CAQH, Availity, and payer portals.
• Proficient in handling EDI/EFI file structures and transmission protocols.
• Strong organizational and follow-up skills.
• Excellent communication and problem-solving abilities.
• Familiarity with HIPAA regulations and CMS requirements.

Job Type: Full-time

Pay: Rs70,000.00 - Rs100,000.00 per month

Work Location: In person