credentialing manager

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 collaborationJob Type: Full-timePay: 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

We are looking for a Credentialing Specialist to join our team and oversee administrative tasks dealing with our health facility&rsquo;s credentialing.Credentialing Coordinator responsibilities include maintaining and verifying files and tracking the expiration of certifications throughout the organization.Ultimately, you will work with different departments across our organization to ensure staff members have the necessary accreditations needed throughout the year.Responsibilities<ul><li>Identify discrepancies in information and conduct follow-ups</li><li>Present applications to the facility&rsquo;s Credentialing Committee</li><li>Assist customers with credentialing inquiries</li><li>Respond to health plan provider inquiries</li><li>Capture primary source documentation in computer databases</li><li>Ensure data is backed up</li><li>Follow compliance laws, regulations, procedures, and policies</li></ul>Requirements and skills<ul><li>Proven work experience as a Credentialing Coordinator or similar role</li><li>Excellent verbal and written communication skills</li><li>Expertise with Microsoft Office Word and Excel</li><li>Proficient touch-typing skills</li><li>Ability to focus for extended periods</li><li>Relevant training and/or certifications as a Credentialing Coordinator</li></ul>Benefits: Increment after Probation Annual Increment Free Meal/Tea Career GrowthJob Type: Full-timePay: Rs50,000.00 - Rs100,000.00 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 Specialist

Macrise Tech Solutions

Organization: One Behavioral Health &amp; Alara Healthcare Location: Wapda Town, LahoreOne Behavioral Health and Alara Healthcare provide high-quality outpatient and inpatient behavioral health services for adults and children across the Houston area. As our organization grows, we are seeking a highly organized and detail-oriented Credentialing Specialist to ensure provider compliance, support smooth healthcare operations, and maintain high standards of patient care.Role OverviewAs a Credentialing Specialist, you will manage the full lifecycle of provider credentialing and re-credentialing across multiple networks and platforms. Your attention to detail, proactive approach, and follow-through will ensure providers remain compliant with payer, regulatory, and hospital requirements, directly supporting efficient billing, timely authorizations, and quality patient care.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Maintain and update provider credentialing files for commercial and government payers.</li><li>Manage CAQH profiles and ensure compliance with CMS and payer-specific standards.</li><li>Process initial credentialing and re-credentialing applications for Medicare, Medicaid, and private insurers.</li><li>Handle applications and renewals for professional licenses, DEA registration, and controlled substance permits.</li><li>Complete government and regulatory revalidation processes within required timelines.</li><li>Coordinate hospital credentialing, maintain provider privileges, and manage ongoing affiliations.</li></ul>Collaboration &amp; Support<ul><li>Work closely with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials and authorization issues.</li><li>Ensure provider information is accurate across CAQH, PECOS, NPPES, CMS databases, and internal systems.</li><li>Maintain an internal credentialing grid with provider credentials, renewal dates, and login details.</li><li>Provide administrative support for audits, compliance checks, and related documentation as required.</li></ul>Ideal Candidate Profile<ul><li>Strong knowledge of healthcare credentialing standards, payer requirements, and regulatory compliance.</li><li>Excellent organizational skills with meticulous attention to detail and accuracy.</li><li>Experience with credentialing platforms such as CAQH, PECOS, and NPPES.</li><li>Ability to manage multiple tasks independently while collaborating effectively with internal teams.</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Provider Credentialing

MaxRemind

We Are Hiring: Credentialing Calling Executive, Junior Credentialing Executive, Credentialing Audit ExecutiveAbout the Role: We are seeking a motivated and detail-oriented Credentialing Calling Executive, Junior Credentialing Executive, Credentialing Audit Executive to join our healthcare operations team. The ideal candidate will handle professional communication with insurance payers, verify credentialing details, and ensure accuracy and compliance across provider data systems.Key Responsibilities:<ul><li>Make outbound and inbound calls to insurance payers to verify and update credentialing information.</li><li>Ensure all data and documentation are accurate, complete, and up to date.</li><li>Maintain records in credentialing databases and assist with application submissions.</li><li>Coordinate with internal teams to follow up on pending information or approvals.</li><li>Adhere to process guidelines, confidentiality policies, and quality standards.</li></ul>Requirements:<ul><li>Excellent verbal and written communication skills in English.</li><li>Strong attention to detail with proficiency in MS Office applications.</li><li>Willingness to work in night shifts (US process).</li><li>Positive attitude with a collaborative and professional work ethic.</li><li>Bachelor&rsquo;s degree in any discipline.</li><li>0 months to 1 year of experience, preferably in BPO, healthcare operations and Credentialing.</li></ul>What We Offer:<ul><li>Competitive salary package</li><li>Dinner and Tea provided</li><li>Opportunities for career growth and professional development</li><li>Supportive and collaborative work environment</li></ul>Location: Near Old Airport Fazal Town Phase 2, Rawalpindi Shift: Evening Shift 6 PM to 3 AM (Mon-Fri) Email: hr@mremind.com Website: www.maxremind.comJob Type: Full-timePay: Rs50,000.00 - Rs70,000.00 per monthWork Location: In person

The Credentialing Team Lead oversees the daily operations of the credentialing team to ensure accurate, efficient, and compliant processing of provider applications, verifications, and re-credentialing activities. This role serves as the primary liaison between the credentialing team, leadership, and other departments to maintain compliance with regulatory and payer requirements. The Team Lead is responsible for workflow coordination, staff training, quality assurance, and continuous process improvement within the credentialing function.Key Responsibilities:Leadership &amp; Team Oversight&middot; Supervise day-to-day credentialing activities to ensure timely and accurate completion of all provider files.&middot; Assign and monitor workloads to meet departmental goals and service level agreements (SLAs).&middot; Provide ongoing coaching, performance feedback, and training to credentialing specialists.&middot; Support new team members through onboarding and mentoring.Credentialing Operations&middot; Review and approve credentialing files prior to submission to payers or committees.&middot; Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal guidelines.&middot; Coordinate initial credentialing, re-credentialing, and primary source verification processes.&middot; Assist in the maintenance and auditing of credentialing databases and systems (e.g., CAQH, Cactus, Verity, or other platforms).&middot; Respond to escalated provider and payer inquiries in a timely and professional manner.Quality &amp; Compliance&middot; Monitor quality control measures to ensure data accuracy and regulatory compliance.&middot; Prepare reports and metrics on credentialing performance, turnaround times, and productivity.&middot; Support internal and external audits and ensure corrective actions are implemented as needed.&middot; Stay current with evolving industry regulations and best practices.Process Improvement &amp; Collaboration&middot; Identify workflow gaps and lead process improvement initiatives.&middot; Collaborate cross-functionally with provider enrollment, contracting, and human resources teams.&middot; Recommend system enhancements and contribute to policy and procedure updates.Qualifications:Education &amp; Experience&middot; Bachelor&rsquo;s degree preferred (Healthcare Administration, Business, or related field).&middot; Minimum 3&ndash;5 years of experience in provider credentialing or medical staff services.&middot; At least 1&ndash;2 years of experience in a leadership, senior, or team lead capacity preferred.Knowledge, Skills &amp; Abilities&middot; In-depth understanding of credentialing standards (NCQA, URAC, CMS, and state requirements).&middot; Strong organizational and multitasking abilities with keen attention to detail.&middot; Excellent written and verbal communication skills.&middot; Proficiency in credentialing software and Microsoft Office Suite.&middot; Ability to lead, motivate, and develop team members in a fast-paced environment.Job Type: Full-timePay: Rs70,000.00 - Rs110,000.00 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 Team Lead

CrystalVoxx Ltd.

About Company:-CrystalVoxx Ltd, a KPO providing end to end service in Revenue Cycle Management (RCM), Credentialing, Medical Coding, Medical Transcription, Virtual Assistance to doctors / providers in US Healthcare Industry.Job Description:-<ul><li>Location:- Ahmedabad</li><li>Shift:- 5:30 PM to 2:30 AM</li><li>Working Days:- Monday to Friday</li></ul>Roles &amp; Responsibilities:<ul><li>Completes providers credentialing, re-credentialing applications; monitors applications, and follows-up as needed.</li><li>Maintains knowledge of current health plan requirements for credentialing process.</li><li>Tracks license and certification expirations for all providers to ensure timely renewals.</li><li>Ensures practice addresses / Phone number / Fax Number are current with health plans.</li><li>Identifying discrepancies in information and conducting follow-ups.</li><li>Responding to health plan provider inquiries.</li><li>Ensure that facility/providers comply with federal and state regulations regarding licensure.</li><li>Ensure that health-care providers update their certification or licensing on time.</li><li>Create NPPES (National Plan and Provider Enumeration System) and profiles for Medicare and NPI (National Provider Identification)</li><li>Creates and maintains CAQH (Council for Affordable Quality Healthcare) accounts.</li><li>Evaluates and maintains positive working relationships with outside credentialing partners, including health plans, field leadership.</li></ul>Skills required:<ul><li>Minimum 1-2 years credentialing experience is additional.</li><li>Proficient with Windows, MS Office, Outlook, and Internet Explorer</li><li>Excellent time management and organizational skills</li><li>Excellent written and verbal communication skills</li></ul>Job Type: Full-timePay: &#8377;252,000.00 - &#8377;360,000.00 per yearApplication Question(s):<ul><li>What is your current/last CTC?</li><li>What is your notice period?</li><li>What is your expected CTC?</li></ul>Work Location: In person

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