Credentialing Specialist

We are seeking a detail-oriented Credentialing Specialist to manage provider credentialing and enrollment with insurance payers, hospitals, and healthcare networks in North America. The ideal candidate will ensure all provider documents, licenses, and enrollment records are accurate, up-to-date, and compliant with industry standards.Key ResponsibilitiesManage full-cycle credentialing and re-credentialing for providers, including enrollment with Medicare, Medicaid, and commercial insurance payers.Prepare, submit, and track payer applications, ensuring timely approval and minimal enrollment delays.Maintain accurate provider records, including licenses, NPI, DEA, CAQH, malpractice, and certifications.Regularly update and attest CAQH profiles and follow up with payers to resolve pending or denied applications.Monitor expiration dates and ensure all credentials and licenses are renewed proactively.Ensure compliance with payer policies, NCQA, CMS, and state/federal regulations.Collaborate with billing, compliance, and provider management teams to ensure smooth onboarding and reimbursement readiness.Maintain detailed logs, reports, and status updates related to credentialing and enrollment activity.Required QualificationsBachelor’s degree or relevant healthcare administrative experience.4+ years of experience in medical credentialing or payer enrollment.Strong understanding of credentialing standards, CAQH, NPI, PECOS, payer portals, and healthcare compliance.Excellent documentation, organization, and follow-up skills.Familiarity with EHR/EMR and credentialing software (e.g., Modio, OneView, Verity, or similar).Strong attention to detail and ability to work under deadlines.Preferred QualificationsExperience with multi-specialty or multi-provider environments.Knowledge of RCM processes to support billing readiness.Certification such as CPCS or CPMSM (a plus, not required).Core CompetenciesDocumentation AccuracyCompliance & Policy UnderstandingFollow-Up & CoordinationAttention to DetailTime ManagementSuccess Indicators (KPIs)Reduced payer enrollment turnaround timeOn-time renewals with zero lapses in credentialsMinimal application rejections or delaysAccurate and updated CAQH and payer recordsAbout CHI TechnologiesWe want to be the leaders in remote monitoring, diagnosis, and real-time and predictive analysis in healthcare and are looking for candidates who share our passion regarding technology and its long-term impact on healthcare - be a part of an energetic team to realize our dream.Cognitive Healthcare International has offices in Hong Kong, Dubai, Lahore and NUST Islamabad. We are a team of 60+ highly motivated engineers and scientists. Please visit: https://chi-technologies.com/