Credentialing and Medical Billing

Provider Credentialing & Enrollment Specialist

The Provider Credentialing & Enrollment Specialist is responsible for managing the complete credentialing, re-credentialing, and payer enrollment lifecycle for healthcare providers across multiple insurance networks and credentialing platforms. This role requires exceptional organizational skills, attention to detail, and proactive communication to maintain regulatory compliance, support uninterrupted provider participation, and facilitate efficient revenue cycle operations. The position is critical in ensuring accurate provider data, timely payer approvals, and consistent reimbursement processes.

Key ResponsibilitiesCredentialing, Enrollment & Compliance

• Maintain accurate and up-to-date provider credentialing files for government and commercial insurance payers.
• Manage and regularly update CAQH profiles while ensuring compliance with CMS regulations and payer-specific requirements.
• Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and commercial insurance plans.
• Coordinate the submission and renewal of professional licenses, DEA registrations, controlled substance permits, and other required certifications.
• Oversee provider revalidation activities with regulatory agencies and government programs, ensuring all deadlines are met.
• Facilitate hospital credentialing and privileging processes, including provider affiliations and ongoing maintenance requirements.
• Monitor credential expiration dates and proactively initiate renewals to prevent interruptions in payer participation.

Collaboration & Operational Support

• Partner with the Revenue Cycle, Billing, and Operations teams to resolve credentialing-related denials, payer discrepancies, and authorization issues.
• Ensure provider information remains accurate and consistent across CAQH, PECOS, NPPES, CMS, payer portals, and internal databases.
• Maintain a centralized credentialing tracking system that includes provider credentials, enrollment status, participation records, expiration dates, and system access information.
• Prepare and organize documentation for credentialing audits, compliance reviews, accreditation requirements, and regulatory inspections.
• Serve as a primary point of contact for credentialing inquiries and coordinate communication with providers, payers, hospitals, and regulatory agencies.

Core Competencies

• Strong knowledge of provider credentialing, payer enrollment, and healthcare compliance requirements.
• Experience with CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer systems.
• Exceptional organizational, follow-up, and documentation management skills.
• Ability to manage multiple deadlines and prioritize tasks in a fast-paced healthcare environment.
• Strong analytical, problem-solving, and communication abilities.

Pay: Rs40,000.00 - Rs70,000.00 per month

Ability to commute/relocate:

• Wapda Town: Reliably commute or planning to relocate before starting work (Preferred)

Application Question(s):

• Willing to work the night shift in Wapda Town, Lahore?

Experience:

• Medical Billing: 1 year (Preferred)

Language:

• English (Preferred)

Work Location: In person