credentialing executive

Speak Viral

The Credentialing Executive is responsible for managing the provider enrollment and credentialing process with insurance companies, hospitals, and other healthcare organizations. This role ensures all providers are properly credentialed and enrolled to receive timely reimbursement for medical services, maintaining compliance with payer and regulatory requirements.Key Responsibilities:&middot; Prepare, review, and submit credentialing and re-credentialing applications for healthcare providers with commercial and government insurance payers (e.g., Medicare, Medicaid, BCBS, Aetna, UnitedHealthcare, Cigna, etc.).&middot; Maintain up-to-date records of providers in credentialing databases and online systems.&middot; Track the status of credentialing and enrollment applications, follow up with payers, and resolve any discrepancies or issues.&middot; Verify provider credentials, including licenses, board certifications, DEA, malpractice insurance, and other necessary documents.&middot; Coordinate with internal billing teams to ensure providers are properly linked and active with payers before billing.&middot; Update and maintain CAQH profiles, NPI registrations, and PECOS enrollments.&middot; Manage expirables (licenses, insurance, certifications) and notify providers of renewals.&middot; Ensure compliance with federal, state, and payer-specific regulations.&middot; Generate and maintain credentialing reports and dashboards.&middot; Communicate professionally with providers, practice managers, and insurance representatives.Required Qualifications:&middot; Bachelor&rsquo;s degree in Healthcare Administration, Business, or a related field (or equivalent work experience).&middot; 1&ndash;3 years of experience in medical credentialing, provider enrollment, or medical billing.&middot; Knowledge of CAQH, NPPES, PECOS, and payer portals.&middot; Strong understanding of commercial and government payer processes.&middot; Excellent communication and organizational skills.&middot; Proficiency in MS Office (Excel, Word, Outlook) and credentialing software.&middot; Ability to handle multiple tasks, prioritize, and meet deadlines.Preferred Qualifications:&middot; Experience with US-based healthcare systems or RCM/BPO companies.&middot; Certification in credentialing (e.g., CPCS, CPMSM) is a plus.&middot; Knowledge of medical billing and compliance regulations (HIPAA, CMS).Key Competencies:&middot; Attention to detail and accuracy&middot; Strong problem-solving and analytical skills&middot; Professional communication and interpersonal skills&middot; Time management and ability to work independently&middot; Team collaborationPay: Rs30,000.00 - Rs50,000.00 per monthApplication Question(s):<ul><li>Will you be able to work in night shift(6pm to 3am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Credentialing Executive

eServMD Pvt. Ltd.

eServMD Pvt Ltd is a service provider company based in Islamabad Pakistan providing services to US-based companies and clients in the field of Electronic Medical Records (EMR), Medical Practice Management, Medical Billing, Real Estate, Accounts &amp; Finance.We are seeking experienced and detail-oriented Credentialing Executive to join our team.Primary Responsibilities:<ul><li>Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications</li><li>Maintain internal provider grid to ensure all information is accurate and logins are available</li><li>Update each provider&rsquo;s CAQH database file timely according to the schedule published by CMS</li><li>Help medical providers to apply or renewal of medical professional licenses; DEA and Controlled Substance etc.</li><li>Complete revalidation requests issued by government payers</li><li>Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid Complete re-credentialing applications for commercial payers</li><li>Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing</li><li>Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases</li></ul>Requirements<ul><li>1-2 years prior Experience in US Medical Credential</li><li>Minimum Bachelor&rsquo;s Degree in Commerce/Finance/Arts/ Pharmacy/ Microbiology or related</li><li>Excellent in English communication skills both verbal &amp; written, spoken English in American pronunciation is desired</li><li>Good Command over Excel, word and health industry related software tools</li><li>Excellent Organizational, Analytical skills and able to adapt to changing situations</li><li>Proven Knowledge of basic medical terminologies such as coding-ICD10, CPT &amp; HCPC</li><li>Experienced in Managing the Overall Revenue Cycle</li><li>Knowledge about Data Conversion and EMR implementation</li><li>Knowledge about enrollment &amp; credentialing and EDI &amp; ERA/EFT setup</li></ul>Job Timings: 5:00 PM to 2:00 AMJob Type: Full-timeAbility to commute/relocate:Job Type: Full-timeWork Location: In person

Sr. Credentialing Executive

Jawa Health Care

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:<ul><li>Handle provider enrollment and credentialing with Medicare, Medicaid, and commercial insurance payers</li><li>Prepare and submit credentialing applications (initial, revalidation, and re-credentialing)</li><li>Maintain and update CAQH profiles and ensure data accuracy</li><li>Track application status and follow up with payers for approvals</li><li>Maintain a database of provider credentials including licenses, certifications, and malpractice insurance</li><li>Ensure compliance with NCQA, CMS, and payer guidelines</li><li>Coordinate with internal departments (billing, compliance, operations)</li><li>Manage re-credentialing timelines and ensure timely renewals</li><li>Resolve credentialing-related issues and denials</li><li>Maintain proper documentation and audit-ready files</li></ul>Required Qualifications:<ul><li>Bachelor&rsquo;s degree (Healthcare Administration preferred)</li><li>1&ndash;3 years of experience in medical credentialing/enrollment (DME experience preferred)</li><li>Strong knowledge of Medicare, Medicaid, and commercial payer processes</li><li>Experience with CAQH, PECOS, NPPES systems</li><li>Good communication and follow-up skills</li></ul>Skills Required:<ul><li>Attention to detail</li><li>Strong organizational skills</li><li>Time management and deadline handling</li><li>Knowledge of healthcare compliance regulations</li><li>Proficiency in MS Office / Excel</li></ul>Preferred Qualifications:<ul><li>Experience in DME (Durable Medical Equipment) credentialing</li><li>Familiarity with US healthcare system</li><li>Prior experience working in night shift (for US-based processes)</li></ul>KPIs / Performance Metrics:<ul><li>Application turnaround time</li><li>Approval rate from payers</li><li>Accuracy of submitted applications</li><li>Re-credentialing completion rate</li><li>Compliance audit results</li></ul>Work Timings (Optional &ndash; Customize):<ul><li>Night Shift (US Time Zone)</li><li>Example: 6:00 PM &ndash; 3:00 AM (PKT)</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Credentialing Executive Medical Billing

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

Interact Global

Credentialing &amp; VOB Executive (Medical Billing &ndash; Night Shift)Salary: PKR 60,000 &ndash; 90,000 (Based on Experience) Job Type: Full-time Experience Required: Minimum 1 Year Location: Wapda Town Phase 1, Lahore Shift: Night Shift (5:30 PM &ndash; 2:30 AM) Schedule: Monday &ndash; Friday (Weekends Off)Job OverviewWe are looking for a detail-oriented Credentialing &amp; VOB Executive with at least 1 year of hands-on experience in US medical billing processes. The ideal candidate will be responsible for provider credentialing, enrollment, and insurance verification while ensuring accuracy and timely processing.Key Responsibilities<ul><li>Manage provider credentialing and enrollment with insurance companies</li><li>Submit and follow up on applications (CAQH, Medicare, Medicaid, commercial payers)</li><li>Perform Verification of Benefits (VOB) including eligibility, co-pays, deductibles, and coverage details</li><li>Communicate with insurance companies via calls and online portals</li><li>Maintain and update records in billing software / CRM systems</li><li>Track credentialing status and resolve delays or rejections</li><li>Ensure compliance with payer requirements and timelines</li></ul>Requirements<ul><li>Minimum 1 year of experience in Credentialing, Enrollment, or VOB</li><li>Basic understanding of US healthcare and insurance processes</li><li>Familiarity with insurance portals (e.g., Availity, Navinet, etc.)</li><li>Good English communication skills (for calls &amp; emails)</li><li>Strong attention to detail and organizational skills</li><li>Ability to work in night shift (US hours)</li></ul>Compensation &amp; Benefits<ul><li>Competitive salary (PKR 60K &ndash; 90K)</li><li>Performance-based increments</li><li>20 (Sick &amp; Casual) Paid annual leaves + 3 paternity &amp; 3 bereavement leaves</li><li>Paid public holidays &amp; US Federal Holiday</li><li>Transport facility for female employees (50% covered)</li><li>Fuel Allowance</li><li>OPD &amp; IPD Allowance</li><li>Career growth in the medical billing domain</li></ul>Who Should Apply?✔ Candidates with at least 1 year relevant experience only ✔ Individuals currently working in medical billing (Credentialing/VOB) ✔ Candidates looking to grow in the US healthcare industryHow to ApplyApply now with your updated CV. Only shortlisted candidates will be contacted.Pay: Rs60,000.00 - Rs90,000.00 per monthWork Location: In person

Credentialing & VOB Executive (Medical Billing – Night Shift)

AffinityVibez (Pvt) Ltd

Credentialing &amp; VOB Executive (Medical Billing &ndash; Night Shift)Salary: PKR 60,000 &ndash; 90,000 (Based on Experience) Job Type: Full-time Experience Required: Minimum 1 Year Location: Wapda Town Phase 1 Shift: Night Shift (5:30 PM &ndash; 2:30 AM) Schedule: Monday &ndash; Friday (Weekends Off)Job OverviewWe are looking for a detail-oriented Credentialing &amp; VOB Executive with at least 1 year of hands-on experience in US medical billing processes. The ideal candidate will be responsible for provider credentialing, enrollment, and insurance verification while ensuring accuracy and timely processing.Key Responsibilities<ul><li>Manage provider credentialing and enrollment with insurance companies</li><li>Submit and follow up on applications (CAQH, Medicare, Medicaid, commercial payers)</li><li>Perform Verification of Benefits (VOB) including eligibility, co-pays, deductibles, and coverage details</li><li>Communicate with insurance companies via calls and online portals</li><li>Maintain and update records in billing software / CRM systems</li><li>Track credentialing status and resolve delays or rejections</li><li>Ensure compliance with payer requirements and timelines</li></ul>Requirements<ul><li>Minimum 1 year of experience in Credentialing, Enrollment, or VOB</li><li>Basic understanding of US healthcare and insurance processes</li><li>Familiarity with insurance portals (e.g., Availity, Navinet, etc.)</li><li>Good English communication skills (for calls &amp; emails)</li><li>Strong attention to detail and organizational skills</li><li>Ability to work in night shift (US hours)</li></ul>Compensation &amp; Benefits<ul><li>Competitive salary (PKR 60K &ndash; 90K)</li><li>First year two times increment on basic salary &amp; then annually</li><li>20 Paid annual leaves + 3 paternity &amp; 3 bereavement leaves</li><li>Paid public holidays &amp; USA Federal Holiday</li><li>Transport facility for female employees (50% covered)</li><li>Fuel Allowance</li><li>Medical Allowance (IPD &amp; OPD)</li><li>Career growth in the medical billing domain</li></ul>Who Should Apply?✔ Candidates with at least 1 year relevant experience only ✔ Individuals currently working in medical billing (Credentialing/VOB) ✔ Candidates looking to grow in the US healthcare industryHow to ApplyApply now with your updated CV. Only shortlisted candidates will be contacted.Job Type: Full-timePay: Rs60,000.00 - Rs90,000.00 per monthWork Location: In person

Credentialing & VOB Officer – Immediate Hiring

CHRISTUS Health

<div>Description 
CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 253-bed hospital serving the fastest-growing area of San Antonio. Specialized care includes orthopedic and surgical care with advanced spine surgery, Intensive Care, complex neurology for treating stroke and other neurovascular issues, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, women&rsquo;s services, a newborn nursery, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, emergency services, and more. The campus also boasts an Outpatient Imaging Center, an Ambulatory Surgery Center, and four medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.
Summary:
Under the direction of the Director of Medical Staff Services, the Medical Staff Coordinator Lead assures the proper credentialing of licensed independent practitioners, physician assistants, nurse practitioners, and certified registered nurse anesthetists. with medical staff privileges. Leads the administrative and documentation support to medical staff services of the facility. Validates, records, transcribes, and maintains all necessary records. Acts as a liaison between the medical staff, medical staff office and physician recruitment committee. Acts as a liaison between the medical staff and other departments of the hospital and provides direction in the coordination of the duties of the medical staff. Maintain a working knowledge of the medical staff bylaws, hospital rules and regulations and hospital policies pertaining to medical staff, practitioner and the organization to ensure the medical staff&rsquo;s adherence within stated parameters.
Responsibilities:
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
As the hospital Credentials Committee Liaison, validates the Practitioner credentialing applications for licensed independent practitioners, physician assistants, nurse practitioners, and certified registered nurse anesthetists, in accordance with accreditation standards, regulatory requirements and policies and procedures in preparation for review by the Credentials Committee.</li><li>
Leads the examination of researches, enters data, files, and gathers all information necessary to process information received from practitioners to support the credentialing process.</li><li>
Researches, develops, and revises, existing privilege sheets to assure they are most current in regard to standard of care and new technology.</li><li>
Responsible for the maintenance and accuracy of electronic credentialing files;</li><li>
Respond to telephone inquiries and written inquiries from practitioners and other departments, pertaining to practitioner and credentialing status in a professional and courteous manner.</li><li>
Facilitate all additions, terminations and changes to practitioners' membership and privileges for processing to the Board of Directors in the secure credentialing software.</li><li>
Medical Staff Organization facilitator of Medical Executive Committees per the bylaws.</li><li>
Maintain a high level of proficiency in the implementation of the medical staff database system modules related to medical staff, practitioners, and the organization to ensure the medical staff's adherence with stated parameters.</li><li>
Maintain compliance with regulatory and accrediting bodies; Joint Commission standards, State and Federal Law pertaining to the Medical Staff and apply them to the credentialing, privileging process as needed.</li><li>
Manage (FPPE) and Ongoing Professional Practice Evaluations (OPPE).</li><li>
Coordinate the Medical Staff's succession and leadership process including the election process of system hospital medical staff leadership in compliance with the medical staff bylaws processes.</li><li>
Facilitate medical staff committee meetings as requested, which includes committee notification, drafting agendas, taking and drafting minutes; and any follow up as required</li><li>
Manage the Practitioner Conduct process as needed per policy.</li><li>
Manage with onboarding process of medical staff and allied health professional candidates.</li><li>
Maintain communication boards and ER Roster or other tasks as assigned.</li></ul>
Requirements:
Education
<ul><li>Associate Degree or equivalent education and experience. Medical terminology training is preferred.</li><li>
Excellent oral and written communication skills</li><li>
Excellent interpersonal skills and work effectively and efficiently with healthcare professionals both in and out of the hospital environment</li><li>
Must be motivated as well as a self-starter who can work independently however capable and willing to take direction as appropriate</li><li>
Knowledge of medical terminology preferred</li><li>
Exhibits a high degree of confidentiality</li><li>
Must possess strong organizational skills</li><li>
Proficient computer skills to operate Microsoft Outlook, Word and Excel.</li></ul>
Experience 
<ul><li>Five (5) years' experience in healthcare</li><li>
A minimum of three (3) years in credentialing physician and allied health professionals</li></ul>
Licenses, Registrations, or Certifications
<ul><li>CPCS (Certified Professional Credentialing Specialist) or CPMSM (Certified Professional Medical Staff Management Certification preferred</li></ul>
Work Schedule: 
5 Days - 8 Hours
Work Type:
Full Time</div>

Coordinator Medical Staff Lead - Med Staff Administration

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