Credentialing Associate

Full Description

About Us:

Hirestaff.ai is a leading global talent acquisition and staffing solutions provider, specializing in connecting businesses with top-tier professionals across various industries. We pride ourselves on our deep industry expertise, cutting-edge technology, and personalized approach to recruitment. At Hirestaff.ai, we're committed to building long-lasting relationships with both clients andcandidates, ensuring the perfect match for every role. We foster a collaborative and supportive work environment where our team members are empowered to excel and make a real impact in the world of talent acquisition.

About the Role:

This is a full-time, onsite position requiring the selected candidate to work night shifts aligned with U.S. Central Time (7 PM – 4 AM PKT). The Credentialing Specialist will be responsible for managing the end-to-end credentialing and enrollment processes for providers specializing in psychiatry and behavioral health services under the U.S. healthcare system.

The role involves handling provider credentialing with Medicare, Medicaid, commercial insurance payers, and hospitals. A strong understanding of Medicare/Medicaid guidelines, commercial payer requirements, CAQH, and credentialing regulations is essential. The ideal candidate must have experience with psychiatric and behavioral health provider enrollments, multi-state submissions, and maintaining compliance across all credentialing activities.

Key Responsibilities:

Medicare Enrollment

• Oversee the full Medicare enrollment process, ensuring compliance with CMS guidelines.

• Verify provider credentials and maintain accurate and up-to-date records.

• Monitor compliance with Medicare regulations and address any policy updates.

• Complete and submit CMS-855I, 855B, and 855R applications as appropriate.

• Ensure 100% accuracy in application submissions to avoid delays.

• Manage address updates and location-based enrollments across multiple states.

• Handle revalidation requests promptly to ensure continued participation in Medicare.

Medicaid Enrollment

• Conduct eligibility checks based on licensure, specialty, and state-specific requirements.

• Collect and verify all necessary documentation before submission.

• Ensure accurate and complete application submission to State Medicaid Agencies.

• Track application status and communicate updates to relevant stakeholders.

• Maintain comprehensive records for compliance and audit readiness.

• Conduct internal audits and training to ensure Medicaid compliance across teams.

Hospital Credentialing

• Manage the end-to-end hospital credentialing process in line with hospital standards and regulatory bodies.

• Collect and verify all necessary documentation including licenses, education, employment history, malpractice insurance, immunizations, case logs, and peer references.

• Facilitate background checks and determine hospital privileges based on qualifications.

• Maintain detailed credentialing files, including meeting minutes and approvals.

• Provide onboarding packets and communicate hospital guidelines to approved providers.

Commercial Insurance Enrollments

• Verify provider documentation such as DEA registration, board certification, and malpractice insurance.

• Manage and update CAQH profiles to ensure accuracy.

• Submit commercial applications within one week of Medicare/Medicaid approval.

• Follow up on applications biweekly, ensuring resolution of discrepancies.

• Regularly monitor the credentialing inbox for payer queries or updates.

• Research and evaluate new payer networks for potential enrollment opportunities.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, or related field preferred.

• At least 1-2 years of experience in credentialing, enrollment, or healthcare administration.

• Familiarity with Medicare/Medicaid processes, CAQH, and commercial payers.

• Strong knowledge of regulatory and compliance standards in healthcare.

• Proficient in MS Office Suite and experience with credentialing software or portals.

• Exceptional attention to detail and organizational skills.

• Excellent verbal and written communication abilities.

• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.