Job Description
Credentialling Specialist – RCM Operations
Experience: Minimum 4 years in Credentialling
Key Responsibilities
- Manage provider enrollment and revalidation with Medicare, Medicaid, and commercial payers
- Complete and submit credentialing applications via CAQH, payer portals, and paper forms
- Track enrollment status and follow up with payers until approvals are obtained
- Maintain provider credentials, including licenses, certifications, and malpractice insurance
- Monitor expiration dates and ensure timely renewals to maintain uninterrupted payer participation
- Maintain accurate provider demographics, specialties, and affiliations across all systems
- Resolve enrollment issues, rejections, and discrepancies through payer communication
- Support internal and external audits by maintaining organized, audit-ready credentialing files
Required Skills
- Minimum 4 years of experience in U.S. healthcare provider credentialing
- Hands-on experience with CAQH, Medicare, Medicaid, and commercial payer enrollment processes
- Strong knowledge of provider credentialing, revalidation, and payer requirements
- Excellent written and spoken English communication skills
- Proficiency in Microsoft Office (Word, Excel, Outlook)
- Strong attention to detail with the ability to manage multiple credentialing tasks simultaneously
Ideal Candidate Profile
We are looking for individuals who:
- Have strong organizational and documentation skills
- Can effectively communicate with insurance payers and healthcare providers
- Demonstrate accuracy and attention to detail in credentialing processes
- Are proactive in tracking renewals and resolving enrollment issues
- Work well independently and collaboratively within a team
- Are committed to maintaining compliance and supporting operational excellence
- Are interested in growing with a fast-growing healthcare operations division
What We Offer
- Opportunity to work with a growing U.S. healthcare organization
- Exposure to automation technologies
- Lucrative compensation package based on experience, work ethic, and enthusiasm
- Opportunity to grow with Rezgateway’s Healthcare Operations Division
Application Process / Requirement
Interested candidates should submit their application within 7 days of this advertisement to hr@rezgateway.com and only shortlisted candidates will be contacted.
In the cover letter, please include a short description of your hands-on experience in provider credentialing and enrollment, including the specific tasks you have performed (such as Medicare, Medicaid, and commercial payer enrollments, CAQH profile management, provider revalidation, enrollment tracking and follow-up, maintaining provider credentials, resolving payer enrollment issues, ensuring regulatory compliance, and supporting credentialing audits). Applications that clearly demonstrate relevant credentialing experience and expertise in managing provider records and payer communications will be given priority during the shortlisting process.
The selection process will include:
- In-person interview in Colombo
- Final interview with the U.S. client via online video meeting
Location: Colombo / Onsite Role
Working Hours: US EST Time Zone