Hi, I’m
Meet Pandya
Credentialing Specialist
Vadodara
Summary
Experienced Credentialing Specialist with 2+ years of expertise in Medicaid, Medicare, and commercial payer credentialing for medical and behavioral health providers. Skilled in managing CAQH, PECOS, NPPES, and CMS databases, ensuring compliance, and maintaining accurate provider profiles. Proficient in handling credentialing processes across multiple states and coordinating with providers, payers, and internal teams. Adept at resolving credentialing issues, monitoring revalidation deadlines, and streamlining enrollment workflows. Strong communicator with a Bachelor of Commerce degree and proficiency in Microsoft Office Suite. Dedicated to delivering efficient, compliant, and seamless credentialing solutions.
Overview
2
years of professional experience
Work History
MDREV Solutions Pvt. Ltd.
Credentialing Specialist
02.2024 - Current
Job overview
- Coordinated directly with clients, managed team workflows, distributed tasks, and resolved quality issues to ensure seamless credentialing processes and compliance.
- Performed credentialing and re-credentialing for providers with commercial and government payers (Medicaid & Medicare).
- Specialized in Medicaid and Medicare credentialing for providers with all major commercial payers.
- Worked with both medical and behavioral health providers to ensure seamless credentialing processes.
- Maintained up-to-date provider files, ensuring compliance with payer requirements.
- Managed credentialing applications for Medicare, Medicaid, and private insurance plans.
- Actively coordinated with doctors to understand and fulfill their credentialing and enrollment needs.
- Facilitated collaboration between providers and payers to ensure smooth enrollment and compliance.
- Ensured timely updates to provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Monitored revalidation deadlines and compliance requirements.
Synergy Business Solutions
Credentialing Specialist
03.2023 - 01.2024
Job overview
- Handled credentialing and re-credentialing processes for individual and group providers across government and commercial payers.
- Ensured provider files were accurate and up-to-date, maintaining internal credentialing records.
- Processed and managed credentialing applications for Medicare, Medicaid, and private insurance networks.
- Assisted providers in keeping their CAQH, PECOS, NPPES, and CMS profiles current.
- Coordinated directly with doctors, clients, and insurance representatives to facilitate a seamless credentialing process.
- Provided support for compliance and documentation reviews to ensure all credentialing requirements were met.
- Maintained open communication with healthcare providers and billing teams to resolve credentialing issues efficiently.
- Experienced in EFT/ERA enrollment, ensuring seamless credentialing processes and compliance.
Education
Vakal Vidyalaya Vadodara, India
High School Diploma
05.2001 - 01.2018
Maharaja Sayajirao University (MSU) Vadodara, India
Bachelor of Commerce
05.2001
Skills
Credentialing and Enrollment
Medicaid and Medicare credentialing
Medical and Behavioral Health Credentialing
Government and commercial insurance credentialing
CAQH, PECOS, NPPES & CMS Database Management
Compliance & Documentation Management
Microsoft Office Suite (Excel, Word)
Strong communication and active listening
Adaptability and problem-solving
EFT and ERA Enrollment