Credentialing Executive Medical Billing

Job Summary:

The Credentialing Executive is responsible for managing the end-to-end provider credentialing and re-credentialing process with insurance payers, ensuring compliance with regulatory standards and maintaining accurate provider records.

Key Responsibilities:

• Handle provider enrollment and credentialing with Medicare, Medicaid, and commercial insurance payers
• Prepare and submit credentialing applications (initial, revalidation, and re-credentialing)
• Maintain and update CAQH profiles and ensure data accuracy
• Track application status and follow up with payers for approvals
• Maintain a database of provider credentials including licenses, certifications, and malpractice insurance
• Ensure compliance with NCQA, CMS, and payer guidelines
• Coordinate with internal departments (billing, compliance, operations)
• Manage re-credentialing timelines and ensure timely renewals
• Resolve credentialing-related issues and denials
• Maintain proper documentation and audit-ready files

Required Qualifications:

• Bachelor’s degree (Healthcare Administration preferred)
• 1–3 years of experience in medical credentialing/enrollment (DME experience preferred)
• Strong knowledge of Medicare, Medicaid, and commercial payer processes
• Experience with CAQH, PECOS, NPPES systems
• Good communication and follow-up skills

Skills Required:

• Attention to detail
• Strong organizational skills
• Time management and deadline handling
• Knowledge of healthcare compliance regulations
• Proficiency in MS Office / Excel

Preferred Qualifications:

• Experience in DME (Durable Medical Equipment) credentialing
• Familiarity with US healthcare system
• Prior experience working in night shift (for US-based processes)

KPIs / Performance Metrics:

• Application turnaround time
• Approval rate from payers
• Accuracy of submitted applications
• Re-credentialing completion rate
• Compliance audit results

Work Timings (Optional – Customize):

• Night Shift (US Time Zone)
• Example: 6:00 PM – 3:00 AM (PKT)

Job Type: Full-time

Pay: Rs40,000.00 - Rs50,000.00 per month

Work Location: In person