Credentialing Executive-Medical Billing

The Credentialing Specialist is responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers across multiple insurance networks, payers, and credentialing platforms. This role requires a proactive professional with strong attention to detail and excellent follow-up skills to ensure ongoing regulatory compliance, uninterrupted provider participation, and efficient billing and authorization workflows. The position plays a key role in maintaining operational continuity and supporting accurate reimbursement processes.

Key ResponsibilitiesCredentialing & Compliance

• Maintain, organize, and regularly update provider credentialing records for both commercial and government payers.
• Manage and monitor CAQH profiles to ensure compliance with CMS regulations and payer-specific credentialing requirements.
• Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and commercial insurance networks.
• Manage applications, renewals, and documentation related to professional licenses, DEA registrations, and controlled substance certifications.
• Complete required provider revalidation processes with government and regulatory agencies within established timelines.
• Coordinate hospital credentialing activities, including provider privileges and maintaining active hospital affiliations.

Collaboration & Operational Support

• Work closely with the Revenue Cycle Director and Billing Team to address credentialing-related denials, payer issues, and authorization delays.
• Ensure provider information is accurate and consistent across CAQH, PECOS, NPPES, CMS databases, and internal credentialing systems.
• Maintain a centralized credentialing tracker, including provider credentials, expiration dates, payer participation status, and system access information.
• Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as required.

Job Type: Full-time

Pay: Rs45,000.00 - Rs70,000.00 per month

Ability to commute/relocate:

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

Application Question(s):

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

Experience:

• Medical Billing: 1 year (Preferred)

Language:

• English (Required)

Work Location: In person