Payer Enrollment & Credentialing Specialist

The Credentialing Specialist is responsible for managing the complete lifecycle of provider credentialing and re-credentialing across various insurance networks, payers, and credentialing platforms. This role requires a proactive, detail-oriented professional with strong follow-up capabilities to ensure ongoing regulatory compliance, uninterrupted provider participation, and efficient billing and authorization workflows. The position plays a critical role in supporting operational efficiency and ensuring accurate, timely reimbursements.

Key ResponsibilitiesCredentialing & Compliance

• Maintain, organize, and regularly update provider credentialing records for both commercial and government payers.
• Oversee and manage CAQH profiles to ensure compliance with CMS regulations and payer-specific credentialing standards.
• 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 provider revalidation processes with government and regulatory bodies within required timelines.
• Coordinate hospital credentialing activities, including managing provider privileges and maintaining active affiliations.

Collaboration & Operational Support

• Work closely with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer concerns, and authorization delays.
• Ensure provider data is accurate and consistent 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 information.
• Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as required

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 (Preferred)

Language:

• English (Required)

Work Location: In person