Credentialing Analyst (End-to-End)

Key Responsibilities

• Verify provider credentials, including licenses, certifications, education, training, work history, DEA, NPI, and malpractice insurance.
• Process payer enrollments, revalidations, and CAQH profile management.
• Ensure timely submission of credentialing applications to insurance payers.
• Follow up with providers, payers, and internal stakeholders regarding application status.
• Maintain accurate provider records and credentialing databases.
• Track expiration dates and coordinate renewals for licenses, certifications, and malpractice coverage.
• Identify and resolve credentialing discrepancies or missing documentation.
• Ensure compliance with NCQA, CMS, Joint Commission, and payer-specific guidelines.
• Collaborate with provider relations, contracting, and operations teams to support onboarding and network participation.
• Perform end-to-end provider credentialing and re-credentialing activities.

Required Qualifications

• Hands-on experience with end-to-end credentialing and payer enrollment processes.
• Knowledge of CAQH, NPI, PECOS, and provider enrollment platforms.
• Excellent verbal and written communication skills.
• Experience working with US healthcare providers and insurance payers.
• Knowledge of medical billing, revenue cycle management, and provider contracting processes.