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credentialing and enrollment executive us healthcare

Top Line Resource Group (TLRG)

Location: DHA phase 8, Lahore (Onsite) Work Schedule: 05PM &ndash; 02AM Pakistan Time Employment Type: Full-time (Night Shift)Topline Resource Group (TLRG) is looking for a knowledgeable Credentialing and Enrollment Specialist to support the provider onboarding process and maintain payer credentialing records. This role focuses on ensuring healthcare providers are successfully enrolled with insurance carriers and that all credentialing documentation remains current and compliant with industry standards.The successful candidate will play an important role in coordinating credentialing activities, maintaining provider records, and communicating with payers to ensure smooth enrollment and approval processes.Core Responsibilities<ul><li>Handle the enrollment process for healthcare providers with insurance payers including Commercial plans, Medicare, Medicaid, and other specialty networks.</li><li>Maintain comprehensive credentialing documentation, ensuring records such as licenses, certifications, DEA registration, NPI information, and CAQH profiles remain accurate and updated.</li><li>Prepare and submit credentialing applications for new provider enrollment, renewals, and information updates with insurance carriers.</li><li>Monitor the progress of submitted applications and follow up with payers to facilitate timely processing and approvals.</li><li>Ensure all credentialing procedures comply with industry standards and payer policies, including NCQA and URAC requirements.</li><li>Review and validate provider documentation to confirm all credentialing criteria and regulatory standards are met.</li><li>Collaborate with internal departments such as Human Resources, Compliance, and Billing to support provider onboarding and credentialing updates.</li><li>Address credentialing discrepancies, assist with payer inquiries, and resolve enrollment-related issues when they arise.</li><li>Maintain organized records and generate reports related to provider enrollment and credentialing activities.</li></ul>Required Experience &amp; Qualifications<ul><li>Minimum 2&ndash;3 years of professional experience in provider enrollment and credentialing within the healthcare industry.</li><li>Strong understanding of U.S. healthcare insurance systems and credentialing workflows.</li><li>Working knowledge of credentialing standards including NCQA, URAC, and payer regulations.</li><li>Experience using credentialing platforms and EHR/Practice Management systems.</li><li>Strong organizational skills with the ability to manage multiple assignments efficiently.</li><li>Excellent written and verbal communication abilities.</li><li>High level of accuracy and attention to detail.</li></ul>Preferred Qualifications<ul><li>Experience handling provider enrollment across multiple U.S. states.</li><li>Ability to work independently in a fast-paced, high-volume environment while meeting deadlines.</li><li>Background in Revenue Cycle Management (RCM), medical billing, or healthcare administration is a plus.</li></ul>Pay: Rs80,000.00 - Rs110,000.00 per monthExperience:<ul><li>enrollment and credentialing: 2 years (Preferred)</li></ul>Work Location: In person

Credentialing and Enrollment Executive - (US Healthcare)

Prima Systems

We are seeking a detail-oriented and experienced Credentialing and Enrollment Associate to join our medical billing team. The ideal candidate will have a strong background in healthcare credentialing and enrollment processes, particularly within the US healthcare system. This role will involve ensuring that healthcare providers are properly credentialed with insurance networks and government programs, facilitating enrollment, and maintaining accurate records.Responsibilities:<ul><li>Manage the credentialing and enrollment process for healthcare providers with insurance networks, Medicare, Medicaid, and other relevant programs.</li><li>Prepare and submit credentialing applications, re-credentialing, and revalidation documents accurately and timely.</li><li>Ensure compliance with all credentialing requirements, regulations, and standards set by accrediting bodies and government agencies.</li><li>Communicate with insurance companies, providers, and internal stakeholders to resolve credentialing issues and inquiries.</li><li>Maintain up-to-date knowledge of current healthcare regulations, policies, and procedures related to credentialing and enrollment.</li><li>Coordinate with internal departments to gather necessary documents and information for credentialing applications.</li><li>Monitor the status of applications, track expirations, and follow up on pending items to ensure timely completion.</li><li>Maintain accurate and organized credentialing and enrollment records, both electronic and paper-based.</li><li>Assist in audits and reviews related to credentialing and enrollment processes.</li></ul>Requirements:<ul><li>Minimum of 2-3 years of experience in healthcare credentialing and enrollment, preferably in a medical billing setting.</li><li>In-depth knowledge of credentialing processes for insurance networks, Medicare, Medicaid, and other payers.</li><li>Familiarity with CAQH, NPI, UPIN, and other relevant healthcare databases and identifiers.</li><li>Strong understanding of healthcare regulations, compliance standards, and HIPAA guidelines.</li><li>Excellent English communication skills, both verbal and written, with the ability to interact professionally with providers and insurance representatives.</li><li>Exceptional attention to detail, accuracy, and organizational skills.</li><li>Proficiency in using MS Office applications and credentialing software.</li><li>Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs130,000.00 per monthApplication Question(s):<ul><li>Are you available for night shift</li></ul>Experience:<ul><li>Credentialing in Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

Credentialing Specialist

We are seeking a detail-oriented and experienced Credentialing and Enrollment Associate to join our medical billing team. The ideal candidate will have a strong background in healthcare credentialing and enrollment processes, particularly within the US healthcare system. This role will involve ensuring that healthcare providers are properly credentialed with insurance networks and government programs, facilitating enrollment, and maintaining accurate records.Responsibilities:<ul><li>Manage the credentialing and enrollment process for healthcare providers with insurance networks, Medicare, Medicaid, and other relevant programs.</li><li>Prepare and submit credentialing applications, re-credentialing, and revalidation documents accurately and timely.</li><li>Ensure compliance with all credentialing requirements, regulations, and standards set by accrediting bodies and government agencies.</li><li>Communicate with insurance companies, providers, and internal stakeholders to resolve credentialing issues and inquiries.</li><li>Maintain up-to-date knowledge of current healthcare regulations, policies, and procedures related to credentialing and enrollment.</li><li>Coordinate with internal departments to gather necessary documents and information for credentialing applications.</li><li>Monitor the status of applications, track expirations, and follow up on pending items to ensure timely completion.</li><li>Maintain accurate and organized credentialing and enrollment records, both electronic and paper-based.</li><li>Assist in audits and reviews related to credentialing and enrollment processes.</li></ul>Requirements:<ul><li>Graduation is mandatory.</li><li>Minimum of 06 months of experience in healthcare credentialing and enrollment, preferably in a medical billing setting.</li><li>In-depth knowledge of credentialing processes for insurance networks, Medicare, Medicaid, and other payers.</li><li>Familiarity with CAQH, NPI, UPIN, and other relevant healthcare databases and identifiers.</li><li>Strong understanding of healthcare regulations, compliance standards, and HIPAA guidelines.</li><li>Excellent English communication skills, both verbal and written, with the ability to interact professionally with providers and insurance representatives.</li><li>Exceptional attention to detail, accuracy, and organizational skills.</li><li>Proficiency in using MS Office applications and credentialing software.</li><li>Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.</li></ul>Job Type: Full-timePay: Rs60,000.00 - Rs75,000.00 per monthApplication Question(s):<ul><li>Are you available for night shift</li></ul>Experience:<ul><li>Credentialing in Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

Credentialing Associate

HBSS ACADEMY

Credentialing SpecialistExperience- 3 to 4 years Provenlocation- J Block, LDA Avenue One LahoreSalary: 100K to 120KTiming- US EST- 6 pm to 3 am in summer and 7 pm to 4 am in winterRoles and Responsibilities<ul><li>Initiate enrollment with insurance companies for all new providers</li><li>Maintain the timelines on enrollment schedules, communicate with billing and the office managers on updates as needed and explain payer information requirements</li><li>Work closely with physicians and office mangers to obtain missing documentation on providers for enrollment with insurance companies</li><li>Follow-up with insurance companies for provider participation status</li><li>Complete re-credentialing for existing providers</li><li>Able to effectively communicate with team members, billing staff and insurance companies</li><li>Retain detailed and accurate lists of insurances for which clients participate</li><li>Performs other related duties, which may be inclusive, but not listed in the job description</li><li>Complete provider credentialing/contract applications with third-party carriers and government health plans.</li><li>Review provider credentialing and contracting information to ensure completeness and accuracy.</li><li>Monitor applications and follow-up in a timely manner.</li><li>Document, maintain and crosscheck client credentials in multiple databases, including CAQH and other third-party databases, as applicable.</li><li>Create, update and track provider information in the internal credentialing system to ensure that credentials are completed timely and correctly.</li><li>Meet or exceed required timeframes for provider communications, enrollments, and follow-ups.</li><li>Maintain quality working relationships with internal and external customers.</li><li>Collect, Submit, &amp; Track all necessary documentation.</li><li>Process re-credentialing for existing clinicians as required by individual payers.</li><li>Maintain a current, accurate database of all clinicians&rsquo; credentialing / licensure status, needs, expirations, issues, etc. Share with internal staff as applicable.</li><li>Communicate &amp; Coordinate with all levels of internal staff &amp; external stakeholders to ensure timely &amp; consistent qualification is met &amp; maintained.</li><li>Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.</li><li>Investigate and resolve any issues that arise during the approval process.</li><li>Under the direction of leadership, assist with site level enrollments or changes to contract.</li><li>Other duties as deemed necessary.</li></ul>Contact HR.hr@thequestmbs.com 03324641025Pay: Rs100,000.00 - Rs120,000.00 per hourExpected hours: 45.0 per weekWork Location: In person

Diglip

We are seeking a highly experienced Laboratory Billing Specialist / RCM Manager to oversee and optimize all aspects of our diagnostic laboratory billing operations. This role will act as the internal billing authority, working closely with our third-party billing company to ensure clean claim submission, minimize denials, and maximize reimbursement.The ideal candidate must have deep expertise in clinical laboratory billing, coding, payer guidelines, and denial management, and should be capable of identifying gaps, resolving issues, and implementing process improvements.Key Responsibilities<ul><li>Oversee and audit the performance of the external billing company</li><li>Review and ensure clean claim submission (first-pass resolution)</li><li>Analyze and resolve denials (CO-45, CO-97, CO-16, PR-96, etc.)</li><li>Identify root causes of denials and implement corrective workflows</li><li>Monitor AR (Accounts Receivable) and aging reports</li><li>Ensure proper usage of CPT codes, ICD-10 codes, modifiers (e.g., 59, 91, 25)</li><li>Validate medical necessity compliance (LCD/NCD guidelines)</li><li>Manage payer-specific requirements (Medicare, Medicaid, BCBS, Aetna, UHC, etc.)</li><li>Work on eligibility verification and benefits investigation</li><li>Review EOBs/ERAs and payment posting accuracy</li><li>Ensure proper credentialing and enrollment (NPI, CLIA, PECOS, CAQH)</li><li>Maintain compliance with HIPAA and CMS billing regulations</li><li>Coordinate with lab operations for proper test coding &amp; panel setup</li><li>Optimize workflows for high-volume tests (CBC, CMP, Ferritin, Toxicology, etc.)</li><li>Track rejection trends and clearinghouse errors</li><li>Generate weekly/monthly billing performance reports</li><li>Implement strategies to reduce write-offs and maximize collections</li></ul>Required Skills &amp; ExpertiseCore Billing Knowledge<ul><li>Strong understanding of Laboratory Billing (Clinical &amp; Toxicology preferred)</li><li>Expertise in:</li><li>CPT / HCPCS coding</li><li>ICD-10 diagnosis coding</li><li>Modifiers usage</li><li>Medical necessity rules</li><li>Hands-on experience with:</li><li>Denial Management &amp; Appeals</li><li>AR Follow-ups</li><li>Insurance Verification</li><li>Charge Entry &amp; Payment Posting</li></ul>Technical &amp; System Skills<ul><li>Experience with LIS (Laboratory Information Systems) and billing software</li><li>Familiarity with Clearinghouses (Office Ally, Change Healthcare, etc.)</li><li>Knowledge of EDI transactions (837, 835, 270/271)</li><li>Ability to audit data between LIS and Billing Systems</li><li>Strong Excel / Google Sheets skills for reporting &amp; analytics</li></ul>Payer &amp; Compliance Knowledge<ul><li>Experience handling:</li><li>Medicare / Medicaid billing</li><li>Commercial insurance (BCBS, Aetna, UHC, Cigna, etc.)</li><li>Understanding of:</li><li>LCD/NCD policies</li><li>Frequency limitations</li><li>Bundling &amp; unbundling rules</li><li>Familiarity with CLIA regulations for lab billing</li></ul>Credentialing &amp; Enrollment<ul><li>Experience with:</li><li>Provider Enrollment (PECOS, CAQH)</li><li>NPI registration and maintenance</li><li>CLIA certification handling</li><li>Ability to ensure lab is properly enrolled with all payers</li></ul>Preferred Qualifications<ul><li>Experience working with high-complexity labs or toxicology labs</li><li>Prior experience managing or auditing outsourced billing teams</li><li>Knowledge of HL7 integrations and lab-machine workflows</li><li>Certification such as:</li><li>CPB (Certified Professional Biller)</li><li>CPMA / CPC (AAPC)</li></ul>Key Performance Indicators (KPIs)<ul><li>Reduction in denial rate (%)</li><li>Increase in clean claim rate</li><li>Improvement in AR days</li><li>Recovery of underpaid / denied claims</li><li>Accuracy in coding and billing compliance</li></ul>Note: Candidates without hands-on lab billing experience will not be considered.Job Type: Full-timePay: Rs150,000.00 - Rs200,000.00 per monthApplication Question(s):<ul><li>How many years of US laboratory billing experience do you have?</li><li>Have you worked with denial codes like CO-45, CO-97, CO-16, PR-96?</li><li>Are you comfortable working onsite and night shifts (US hours)?</li></ul>Work Location: In person

Laboratory Billing Specialist / Revenue Cycle Manager (RCM)

RK Med Pro

I am looking to hire the credentialing Lead for one of my client located in DHA # 8, Lahore.Requirements:<ul><li>Manage provider credentialing and re-credentialing processes with insurance payers, hospitals, and regulatory bodies.</li><li>Prepare, submit, and track credentialing applications, ensuring accuracy and compliance with payer requirements.</li><li>Maintain provider databases, licenses, certifications, and expiration records to ensure continuous participation.</li><li>Communicate with providers and insurance representatives to resolve credentialing issues and prevent enrollment delays.</li></ul>Salary: 100K - 150KSend resume at 03018408069Job Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthWork Location: In person

Credentialing Lead

Physician Cure

Credentialing Executive with the experience of 1-2 years is required in Tritech services Medical billing company located at 20-L Ex air avenue DHA phase 8 Lahore. Whatsapp 0326-4565645. Shift timings 7:00pm to 04:00am.Job Type: Full-timePay: Rs60,000.00 - Rs70,000.00 per monthWork Location: In person

Credentialing Executive for Medical Billing company

Explore 1877+ Credentialing and enrollment executive us healthcare in Lahore this April. Find roles across top companies and apply now to boost your career.

1877 credentialing and enrollment executive us healthcare jobs In Lahore

Credentialing and Enrollment Executive - (US Healthcare)

Credentialing Specialist

Credentialing Associate

Credentialing Specialist

Laboratory Billing Specialist / Revenue Cycle Manager (RCM)

Credentialing Lead

Credentialing Executive for Medical Billing company