<p>The Credentialing Specialist is responsible for coordinating, processing, and tracking healthcare provider licenses (MDs, DOs, NPs, RNs, etc.) across multiple U.S. states, including through licensure compacts (IMLC/NLC). This role ensures timely, accurate, and compliant onboarding and re-credentialing of providers in accordance with regulatory and organizational standards<br /><br />Key Responsibilities:<br /><br />1. State Licensing Coordination<br /><br />Prepare and submit new license applications, renewals, and updates with state medical/nursing boards.<br /><br />Monitor license expiration dates and proactively manage renewals to avoid lapses.<br /><br />Liaise with state boards to resolve delays or discrepancies in applications.<br /><br />Maintain thorough knowledge of state-specific requirements, timelines, and fees.<br /><br />2. Licensure Compact Programs (IMLC/NLC)<br /><br />Process multistate licenses under Interstate Medical Licensure Compact (IMLC) or Nurse Licensure Compact (NLC) rules.<br /><br />Keep up to date with changes in compact states, eligibility criteria, and documentation needs.<br /><br />3. Credentialing Support<br /><br />Complete primary source verification (PSV) for licenses, education, DEA, board certification, OIG/SAM exclusions, etc.<br /><br />Work closely with credentialing analysts to ensure data accuracy in credentialing databases (e.g., Cactus, Modio, symplr, Citrix etc..).<br /><br />4. Data Management & Reporting<br /><br />Maintain detailed, audit-ready records of licensing activities.<br /><br />Generate regular reports on licensing status, pending applications, and expirations.<br /><br />Update internal systems and provider directories with current licensure information.<br /><br />5. Stakeholder Communication<br /><br />Act as a point of contact for providers regarding licensing requirements, timelines, and documentation.<br /><br />Collaborate with credentialing, compliance, and provider relations teams if required<br /><br />6. Audit & Compliance<br /><br />Support internal and external audits (e.g., NCQA, URAC, Joint Commission).<br /><br />Ensure adherence to CMS, state, and accrediting body standards.<br /><br />Required Skills and Qualifications:<br /><br />Bachelor’s degree or equivalent experience in healthcare administration or a related field.<br /><br />2–5 years of experience in credentialing, licensing, or provider enrollment.<br /><br />Knowledge of state licensure processes for MDs, DOs, NPs, and RNs.<br /><br />Familiarity with IMLC, NLC, and digital application portals (e.g., FCVS, BREEZE).<br /><br />Strong organizational skills with attention to detail and deadlines.<br /><br />Proficiency in credentialing software (e.g., Cactus, Verity, Modio, symplr).<br /><br />Excellent communication and follow-up skills.<br /><br />Preferred Qualifications:<br /><br />NAMSS certification (CPCS or CPMSM) a plus.<br /><br />Experience in multi-state or telehealth provider licensing.</p><h3>experience</h3>6

Job Description: Provider Enrollment Follow-up Specialist (PE – Follow-up)  Role Title: Provider Enrollment Follow-up Specialist<br />Department: Provider Operations<br />Location: Hyderabad – Work From Office (WFO only)<br />Experience Required: 1–3 years in healthcare voice processes (Provider Enrollment preferred, but AR/RCM/Healthcare Voice also acceptable)<br />Mission of the Role<br />To ensure timely and accurate follow-up with payers for provider enrollment applications by using professional phone and email communication, resolving pending issues, and supporting the enrollment lifecycle through high-quality interactions.<br />Key Responsibilities<br />1. Payer Follow-ups & Communication<br />● Make outbound calls and send professional emails to payers, enrollment departments,<br />and provider relations teams to check the status of submitted applications.<br />● Document all communication accurately and update status trackers/CRM systems in real<br />time.<br />● Maintain strong phone/email etiquette to represent the provider and the organization<br />professionally.<br />2. Enrollment Status Management<br />● Track all submitted applications—new enrollment, revalidation, demographic updates,<br />and terminations.<br />● Identify missing information, additional documentation requirements, or payer-specific<br />clarifications.<br />● Escalate urgent or stuck applications to the Senior Analyst/Team Lead.<br />3. Issue Identification & Resolution<br />● Research and troubleshoot issues such as incorrect provider data, incomplete<br />documentation, NPI/taxonomy mismatches, or portal discrepancies.<br />● Coordinate with internal teams (Enrollment, Credentialing, Data Management) to resolve<br />blockers and re-submit required information.<br />● Ensure timely follow-up cycles to avoid processing delays.<br />4. Compliance & Documentation<br />● Adhere to payer-specific guidelines, call handling standards, and documentation norms.<br />● Ensure all communication, follow-ups, and payer responses are captured accurately for<br />audit and compliance purposes.<br />● Follow HIPAA and internal confidentiality standards.<br /><br />5. Workflow & Productivity Management<br />● Work efficiently through daily call queues and email follow-up tasks.<br />● Prioritize escalations and time-sensitive cases based on SLO/TAT expectations.<br />● Participate in huddles, training sessions, and process updates as required.<br /><br />Required Qualifications<br />● Experience in Provider Enrollment OR Healthcare Voice Processes<br />such as AR calling, RCM calling, prior authorization, or patient services.<br />● Strong phone etiquette, email writing skills, and clarity in communication.<br />● Ability to handle payer conversations confidently and professionally.<br />● Basic understanding of healthcare provider types, NPI, CAQH, and payer enrollment<br />workflows (preferred but not mandatory).<br />● Comfortable working in a fast-paced, metric-driven operational environment.<br /><br />Preferred Skills<br />● Experience using payer portals, CRM tools, or workflow management systems.<br />● Exposure to provide credentialing or healthcare operations.<br />● Ability to identify issues and communicate them effectively to senior team members.<br /><br />Work Environment & Expectations<br />● Work From Office – Hyderabad (mandatory).<br />● Requires strong discipline in documentation, follow-up cycles, and adherence to<br />communication standards.<br />● Willingness to work aligned to U.S. payer hours as required.--<h3>experience</h3>4