Company Description Proficio Therapy Services provides pediatric ABA, speech, and occupational therapy designed to support children and families through individualized, compassionate care. Serving communities in California and Utah, including South Jordan, the team helps children build communication, social, behavioral, and daily living skills in a supportive environment. The organization partners closely with families, celebrates progress, and strives to create meaningful outcomes for every child. Through specialized programs such as AGES Learning Solutions (ABA services) and Child's Play (pediatric occupational therapy), Proficio offers comprehensive support tailored to each child's needs. Committed to expanding access to quality pediatric therapy, Proficio works to make a positive impact locally and globally.
Role Description The Credentialing Specialist is a full-time, on-site role based in Thane. This role is responsible for managing provider credentialing processes, including collecting, verifying, and updating practitioner information for insurance panels, hospitals, and regulatory bodies. The specialist coordinates with internal teams and external organizations to ensure timely submission of applications and re-credentialing, maintains accurate records in credentialing databases, and monitors expiration dates for licenses, certifications, and contracts. Day-to-day tasks include reviewing documentation for completeness, resolving credentialing discrepancies, responding to provider and payer inquiries, and supporting compliance with organizational and regulatory standards. The person in this role collaborates with clinical and administrative staff to support smooth onboarding of new providers and continuity of care for clients.
Responsibilities and Duties:
- Manage the end-to-end provider credentialing and recredentialing process for physicians, therapists, BCBAs, SLPs, OTs and other healthcare professionals.
- Prepare, submit, and track credentialing applications with commercial insurance payers, Medicare, Medicaid, and other healthcare networks.
- Ensure timely completion and submission of provider enrollment, revalidation, and recredentialing applications.
- Maintain accurate provider records, licenses, certifications, malpractice insurance, DEA registrations, NPI information, and other required documentation.
- Monitor credentialing expiration dates and proactively initiate renewal activities to prevent disruptions in provider participation and billing.
- Follow up with insurance payers, credentialing organizations, and regulatory agencies regarding application status and pending requirements.
- Maintain and update provider information within credentialing databases, CAQH, payer portals, and internal systems.
- Coordinate with providers and internal teams to obtain required documentation and resolve credentialing-related issues.
- Track credentialing turnaround times and maintain detailed records of application submissions, approvals, denials, and expirations.
- Ensure compliance with payer requirements, CMS regulations, NCQA standards, and organizational policies.
- Support provider onboarding by facilitating timely credentialing and enrollment processes.
- Investigate and resolve credentialing discrepancies, application rejections, and enrollment delays.
- Assist with audits and compliance reviews by maintaining accurate and organized credentialing documentation.
- Generate credentialing status reports, provider enrollment reports, and operational metrics for leadership review.
- Develop and maintain credentialing workflows, SOPs, and process documentation.
- Collaborate with Revenue Cycle Management, Human Resources, Compliance, Clinical Operations, and Provider Relations teams to ensure smooth provider onboarding and credentialing processes.
- Stay current with changes in payer requirements, credentialing regulations, provider enrollment guidelines, and industry best practices.
Qualifications
- Bachelor's degree in Healthcare Administration, Business Administration, Life Sciences, or a related field.
- 2–5 years of experience in US Healthcare Credentialing, Provider Enrollment, or Medical Staff Services.
- Strong knowledge of provider credentialing, recredentialing, payer enrollment, and provider data management processes.
- Experience working with commercial insurance payers, Medicare, Medicaid, and CAQH.
- Familiarity with NCQA standards, CMS regulations, and healthcare credentialing best practices.
- Experience managing provider licenses, certifications, malpractice insurance, and regulatory documentation.
- Strong attention to detail and ability to manage multiple credentialing applications simultaneously.
- Excellent organizational, communication, and follow-up skills.
- Proficiency in Microsoft Office Suite, credentialing software, and payer portals.
- Experience supporting behavioral health, ABA, therapy, or multi-specialty healthcare organizations is preferred.
- Professional certifications such as CPCS (Certified Provider Credentialing Specialist) or CPMSM are an advantage but not required.
Work Schedule:
- Full-Time – Hybrid (Kochi)
- Night Shift to support US operations and payer working hours.
- Ability to collaborate with US-based teams and accommodate operational requirements as needed.
Work Environment:
- Fast-paced healthcare revenue cycle environment supporting ABA services.
- Regular interaction with insurance payers, healthcare providers, licensing boards, and internal stakeholders.
- Opportunity to work closely with Revenue Cycle Management, Compliance, Clinical Operations, and Provider Relations teams.
- Collaborative work environment requiring strong attention to detail and adherence to deadlines.
Compensation & Benefits:
- Salary: 38000 - 45000
- Annual Performance Bonus.
- Medical Insurance Coverage.
- Paid time off.
- Opportunity to lead and scale revenue cycle operations within a rapidly growing international healthcare organization.
