Provider Credentialing Associate

Dear Candidate,
About Company
Edvak is a US-based SaaS company transforming the healthcare sector with our innovative AI solutions. We are dedicated to excellence, creativity, and innovation, delivering exceptional services to our clients. Our operations in India are based in the vibrant city of Hyderabad.
As we continue to expand, we are looking for a dynamic Content Strategist/Marketer to lead our content marketing efforts and drive Edvak's success in a competitive market.
Website: www.edvak.com
Address:
IndiQube Pearl, Beside Rolling Hills and Ramky Towers, Mindspace Rd, P Janardhan Reddy Nagar, Gachibowli, Telangana 500032
Position: Provider Credentialing Associate
Experience: 3–5 Years preferred
Domain: US Healthcare / Provider Credentialing
Responsibility: Independent end-to-end management of assigned client accounts
We are looking for an experienced Provider Credentialing Associate who can independently manage the complete credentialing and payer enrollment activities for an assigned healthcare client.
Key Responsibilities
Independently manage provider credentialing and enrollment for assigned clients.
Complete initial credentialing, recredentialing, and payer enrollment with Medicare, Medicaid, and commercial insurance plans.
Maintain and update CAQH profiles and attestations.
Handle PECOS, NPPES, state Medicaid portals, Availity, payer portals, and other enrollment systems.
Submit and follow up on group and individual provider enrollments.
Manage NPI–TIN affiliations, practice/location additions, demographic changes, EFT and ERA enrollments.
Track applications from submission through approval and maintain accurate credentialing trackers.
Follow up directly with payers regarding pending, returned, or rejected applications.
Verify effective dates and participation/network status before communicating completion.
Maintain provider documents such as licenses, DEA, malpractice insurance, W-9, board certifications, and other required credentials.
Monitor expiration dates and proactively initiate renewals/recredentialing.
Coordinate directly with providers/practice administrators to obtain missing documentation.
Communicate credentialing status, pending items, risks, and expected timelines clearly to the client.
Coordinate with the billing team to ensure claims are submitted only according to the provider's payer enrollment/effective-date status.
Troubleshoot enrollment-related claim issues such as provider not enrolled, NPI/TIN mismatch, invalid Medicaid provider ID, and provider not affiliated with the group.
Maintain confidentiality and follow HIPAA requirements.
Required Skills
3–5 years of hands-on US healthcare provider credentialing/enrollment experience.
Strong experience with Medicare, Medicaid, and commercial payer enrollment.
Working knowledge of CAQH, PECOS, NPPES, Availity and payer portals.
Understanding of Type 1/Type 2 NPI, TIN, PTAN, taxonomy, group affiliations, ERA and EFT enrollment.
Strong payer follow-up and documentation skills.
Excellent written and verbal communication.
Ability to independently own a client account, prioritize pending items, and provide regular status updates with minimal supervision.
Preferred Candidate: Someone who can take complete ownership of a client from provider onboarding → credentialing/enrollment → payer follow-up → approval/effective-date verification → handoff to billing, while serving as the primary credentialing point of contact for the client.

Work arrangement
No