Credentialing & Provider Enrollments Executive-Medical Billing

The Credentialing Specialist is responsible for overseeing the full lifecycle of provider credentialing and re-credentialing across multiple insurance networks, payers, and credentialing platforms. This role requires a proactive and detail-oriented individual with strong follow-up skills to ensure continuous compliance with regulatory standards, uninterrupted provider participation, and smooth billing and authorization processes. The position plays a vital role in maintaining operational efficiency and supporting accurate and timely reimbursements.

Key ResponsibilitiesCredentialing & Compliance

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

Collaboration & Operational Support

• Partner with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer issues, and authorization delays.
• Ensure accuracy and consistency of provider information across CAQH, PECOS, NPPES, CMS databases, and internal systems.
• Maintain a centralized credentialing tracker, including provider credentials, expiration dates, payer participation status, and system access details.
• Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as needed

Job Type: Full-time

Pay: Rs45,000.00 - Rs80,000.00 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:

• Credentialing: 1 year (Required)

Language:

• English (Required)

Work Location: In person