Credentialing and Contracting Associate

Role Overview Human Xpert India Private Limited is seeking an experienced Credentialing and Contracting Associate to manage end-to-end provider credentialing and payer contracting across both physician and hospital/institutional settings for US healthcare clients. This full-time US shift role based in Chennai offers direct exposure to physician and facility contracting across multiple American states and specialties. The ideal candidate brings 3 to 6 years of hands-on experience in professional and institutional billing environments, with a thorough understanding of payer enrollment, fee schedule negotiation, and healthcare compliance frameworks. Key Responsibilities - Prepare, submit, and track initial and re-credentialing applications for individual physicians, NPs, PAs, CRNAs, and facility-based providers - Manage hospital medical staff applications, coordinate with Medical Staff Offices for privilege letters, and monitor committee review timelines - Handle payer enrollment for physicians and non-physician practitioners with Medicare via PECOS, Medicaid, and commercial payers including Aetna, BCBS, UnitedHealthcare, Cigna, and Humana - Review and negotiate physician fee schedules and contract terms by benchmarking against Medicare RBRVS and national fee schedule data - Submit and track CMS-855I, CMS-855R, CMS-855A, and CMS-855B applications and manage full provider agreement lifecycles - Manage payer contracting and enrollment for hospitals, ASCs, SNFs, and other institutional providers including DRG, APR-DRG, per diem, and facility fee schedule negotiations - Maintain accurate provider and facility records across CAQH ProView, PECOS, NPPES, Availity, and client-specific credentialing platforms - Ensure compliance with NCQA, CMS, URAC, Joint Commission, HIPAA, and all applicable state and federal regulations - Collaborate with billing, coding, AR, and scheduling teams to align credentialing and contracting status with billing readiness for professional and facility claims - Prepare comparative fee schedule analyses and payer reimbursement benchmarking reports to support rate negotiation strategy Required Qualifications - Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field - 3 to 6 years of experience in physician credentialing, payer enrollment, and hospital or facility contracting - Hands-on proficiency with PECOS, CAQH ProView, NPPES, Availity, and payer-specific portals - Strong knowledge of HIPAA, NCQA, CMS regulations, and state credentialing requirements - Ability to manage 50 or more active credentialing applications simultaneously with high attention to detail - Proficiency in Microsoft Excel or Google Sheets for tracking and fee schedule analysis Why Join Us Human Xpert India is a high-growth RCM company offering real career advancement through direct involvement in payer strategy, contract negotiation, and credentialing leadership across multiple US specialties and states. You will thrive in a collaborative, vision-driven environment where leadership is invested in each team member's professional growth.

- 3 to 6 years of experience in physician and facility credentialing and payer enrollment - Hands-on experience with PECOS CMS-855I, CMS-855R, CMS-855A, and CMS-855B submissions - CAQH ProView profile management and attestation cycle experience - Knowledge of Medicare RBRVS, physician fee schedule analysis, and professional contract negotiation - Experience with hospital medical staff applications and MSO coordination - Familiarity with DRG, APR-DRG, per diem, and facility fee schedule structures - Proficiency with credentialing portals including CAQH, PECOS, NPPES, and Availity - Strong working knowledge of HIPAA, NCQA, CMS, and state credentialing regulations - Experience enrolling with Medicare, Medicaid, Aetna, BCBS, UHC, Cigna, and Humana - Excellent written and verbal communication skills for payer interactions and internal reporting - Proficiency in Microsoft Excel or Google Sheets for fee schedule tracking and analysis - Bachelor's or Associate's degree in Healthcare Administration or related field

- Exposure to US healthcare accounts across multiple specialties and states - Direct involvement in contract negotiation and payer strategy - Career growth opportunities within a high-growth RCM organisation - Collaborative and vision-driven work culture - Strong leadership investment in team member development