Credentialing and Enrollment Executive - (US Healthcare)

Location: DHA phase 8, Lahore (Onsite)
Work Schedule: 05PM – 02AM Pakistan Time
Employment Type: Full-time (Night Shift)

Topline Resource Group (TLRG) is looking for a knowledgeable Credentialing and Enrollment Specialist to support the provider onboarding process and maintain payer credentialing records. This role focuses on ensuring healthcare providers are successfully enrolled with insurance carriers and that all credentialing documentation remains current and compliant with industry standards.

The successful candidate will play an important role in coordinating credentialing activities, maintaining provider records, and communicating with payers to ensure smooth enrollment and approval processes.

Core Responsibilities

• Handle the enrollment process for healthcare providers with insurance payers including Commercial plans, Medicare, Medicaid, and other specialty networks.
• Maintain comprehensive credentialing documentation, ensuring records such as licenses, certifications, DEA registration, NPI information, and CAQH profiles remain accurate and updated.
• Prepare and submit credentialing applications for new provider enrollment, renewals, and information updates with insurance carriers.
• Monitor the progress of submitted applications and follow up with payers to facilitate timely processing and approvals.
• Ensure all credentialing procedures comply with industry standards and payer policies, including NCQA and URAC requirements.
• Review and validate provider documentation to confirm all credentialing criteria and regulatory standards are met.
• Collaborate with internal departments such as Human Resources, Compliance, and Billing to support provider onboarding and credentialing updates.
• Address credentialing discrepancies, assist with payer inquiries, and resolve enrollment-related issues when they arise.
• Maintain organized records and generate reports related to provider enrollment and credentialing activities.

Required Experience & Qualifications

• Minimum 2–3 years of professional experience in provider enrollment and credentialing within the healthcare industry.
• Strong understanding of U.S. healthcare insurance systems and credentialing workflows.
• Working knowledge of credentialing standards including NCQA, URAC, and payer regulations.
• Experience using credentialing platforms and EHR/Practice Management systems.
• Strong organizational skills with the ability to manage multiple assignments efficiently.
• Excellent written and verbal communication abilities.
• High level of accuracy and attention to detail.

Preferred Qualifications

• Experience handling provider enrollment across multiple U.S. states.
• Ability to work independently in a fast-paced, high-volume environment while meeting deadlines.
• Background in Revenue Cycle Management (RCM), medical billing, or healthcare administration is a plus.

Pay: Rs80,000.00 - Rs110,000.00 per month

Experience:

• enrollment and credentialing: 2 years (Preferred)

Work Location: In person