Credentialing Specialist – US Healthcare

About MantraComply

MantraComply is a healthcare technology and services company that helps healthcare organizations manage provider credentialing, licensing, payer enrollment, compliance and other healthcare operations. We combine technology, automation and healthcare expertise to simplify administrative processes and help providers complete credentialing and enrollment requirements efficiently.

Role Overview

We are looking for a Credentialing Specialist – US Healthcare to manage provider credentialing and enrollment activities for healthcare providers across the United States.

You will work with healthcare providers, credentialing teams and insurance payers to collect and verify provider information, prepare applications, maintain credentialing records and follow up on pending requirements.

Key Responsibilities:

• Manage end-to-end provider credentialing processes for US healthcare providers.
• Collect, review and verify provider documents, including licenses, certifications, education, training, work history and malpractice insurance.
• Create and maintain provider profiles and credentialing information in CAQH and other relevant platforms.
• Prepare and submit credentialing, recredentialing and provider enrollment applications to commercial and government payers.
• Support payer enrollment activities for Medicare, Medicaid and commercial insurance plans.
• Follow up with providers and payers to obtain missing information and resolve application issues.
• Track application status, submission dates, approvals, expirations and recredentialing deadlines.
• Perform primary source verification of provider credentials as required.
• Review provider files for missing information, discrepancies and documentation gaps.
• Maintain accurate provider records and credentialing documentation in internal systems.
• Communicate application updates and pending requirements to relevant internal teams.
• Meet defined turnaround times, quality standards and productivity targets.

Requirements

• 1–4 years of experience in US healthcare credentialing, provider enrollment, payer enrollment or healthcare operations.
• Good understanding of US healthcare provider credentialing and enrollment processes.
• Working knowledge of CAQH, NPI, Medicare, Medicaid and commercial payers.
• Experience reviewing provider credentials and maintaining accurate documentation.
• Strong attention to detail and organizational skills.
• Good written and verbal English communication skills.
• Ability to manage multiple providers, applications and deadlines simultaneously.
• Comfortable working with spreadsheets, web-based applications, CRM platforms and credentialing systems.

Preferred

• Experience handling provider enrollment or payer enrollment applications.
• Experience working with US healthcare practices, hospitals, MSOs, RCM companies or similar healthcare organizations.
• Knowledge of primary source verification, recredentialing and provider data maintenance.
• Familiarity with Medicare, Medicaid and commercial payer portals.
• Knowledge of NCQA credentialing standards.
• Experience tracking provider licenses, certifications, malpractice insurance and other credential expirations.