Acurus Solutions Private Limited
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
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