Credentialing Specialist

About Proficio Therapy Services

Proficio Therapy Services specializes in pediatric ABA, speech, and occupational therapy, focusing on individualized and compassionate care to assist children and families. Operating primarily in California and Utah, including South Jordan, the organization supports children in developing communication, social, behavioral, and daily living skills within nurturing settings. Through programs like AGES Learning Solutions and Child’s Play, it delivers tailored therapeutic services aimed at fostering meaningful developmental outcomes. Committed to increasing access to quality pediatric therapy, Proficio strives to make a measurable impact locally and globally.

Role Overview

The Credentialing Specialist is a full-time, on-site position based in Kochi, Kerala, dedicated to managing the end-to-end credentialing and recredentialing processes for various healthcare providers such as physicians, therapists, BCBAs, SLPs, and OTs. This role encompasses gathering, verifying, and updating provider credentials for insurance networks, hospitals, and regulatory agencies. The specialist works closely with internal teams and external organizations to ensure prompt submission and approval of credentialing applications while maintaining accurate database records and monitoring credential expirations to prevent participation and billing interruptions.

Key Responsibilities

• Oversee complete credentialing and recredentialing processes for healthcare providers including submission and tracking of applications to insurance payers like Medicare, Medicaid, and commercial networks.
• Ensure timely completion of enrollments, revalidations, and renewals of credentials.
• Maintain detailed and current documentation including licenses, certifications, malpractice insurance, DEA registrations, and NPI details.
• Proactively monitor credential expirations and initiate renewals to avoid service disruptions.
• Communicate regularly with insurance payers, credentialing bodies, and regulatory agencies regarding application statuses and requirements.
• Manage provider data in credentialing databases, CAQH, payer portals, and internal systems.
• Collaborate with providers and departments to gather necessary documentation and solve credentialing issues.
• Keep detailed records and track credentialing timelines, application outcomes, and status reports.
• Ensure adherence to payer policies, CMS regulations, NCQA standards, and organizational compliance protocols.
• Assist in provider onboarding to facilitate seamless integration through timely credentialing.
• Address and rectify any credentialing discrepancies, application denials, or delays.
• Support audits and compliance efforts by maintaining well-organized credentialing files.
• Prepare credentialing and enrollment reports along with operational metrics for leadership review.
• Develop and update standard operating procedures and workflows related to credentialing.
• Coordinate with departments such as Revenue Cycle Management, Human Resources, Compliance, Clinical Operations, and Provider Relations for smooth credentialing processes.
• Stay informed on changes in credentialing regulations, payer requirements, and industry best practices.

Candidate Profile

• Bachelor's degree in Healthcare Administration, Business Administration, Life Sciences, or a related discipline.
• Between 2 and 15 years of experience in US healthcare credentialing, provider enrollment, or medical staff services.
• Comprehensive knowledge of credentialing processes involving commercial insurance, Medicare, Medicaid, and CAQH systems.
• Familiarity with NCQA standards, CMS regulations, and credentialing best practices.
• Experience managing licenses, certifications, malpractice coverage, and regulatory paperwork.
• Strong organizational skills and detailed focus to manage multiple applications simultaneously.
• Excellent communication and follow-up abilities.
• Proficient in Microsoft Office, credentialing software, and payer portals.
• Experience in behavioral health, ABA, therapy, or multi-specialty healthcare environments is advantageous.
• Certifications like CPCS or CPMSM are beneficial but not mandatory.

Working Conditions

• Full-time, on-site position located in Kochi, Kerala.
• Night shifts to align with US operational hours and payer timelines.
• Close collaboration with US-based colleagues and teams.
• Dynamic revenue cycle environment supporting pediatric ABA services with frequent interaction with payers, providers, and stakeholders.
• Team-oriented workplace emphasizing accuracy and deadline adherence.

Compensation & Benefits

• Monthly salary ranging from 38000 to 45000 INR.
• Annual performance-based bonus.
• Medical insurance coverage provided.
• Paid time off benefits.
• Opportunity to lead and expand revenue cycle operations within a growing international healthcare organization.