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credentialing specialist

Speak Viral

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>Job Type: Full-timePay: Rs50,000.00 - Rs70,000.00 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

Physicians Revenue Group

<ul><li>erform end-to-end credentialing and re-credentialing for healthcare providers with US insurance payers</li><li>Handle payer enrollments (Medicare, Medicaid, and commercial plans) to ensure billing readiness</li><li>Maintain and regularly update CAQH profiles, ensuring accuracy for claim processing</li><li>Verify provider eligibility before onboarding to avoid claim rejections/denials</li><li>Coordinate closely with medical billing teams to resolve credentialing-related claim issues</li><li>Monitor and follow up on pending applications to prevent revenue delays</li><li>Ensure all provider data (NPI, taxonomy, licenses, malpractice insurance) is accurate and up to date</li><li>Work on ERA/EFT enrollments to streamline payment processes</li><li>Support denial management by identifying credentialing gaps impacting reimbursements</li><li>Maintain compliance with payer-specific guidelines and regulatory requirements</li><li>Prepare credentialing status reports, turnaround time tracking, and aging reports</li></ul>Job Type: Full-timeWork Location: In person

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

Macrise Tech Solutions

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 &amp; Compliance<ul><li>Maintain, organize, and regularly update provider credentialing records for both commercial and government payers.</li><li>Oversee and manage CAQH profiles to ensure compliance with CMS regulations and payer-specific credentialing standards.</li><li>Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and commercial insurance networks.</li><li>Manage applications, renewals, and documentation related to professional licenses, DEA registrations, and controlled substance certifications.</li><li>Complete provider revalidation processes with government and regulatory bodies within required timelines.</li><li>Coordinate hospital credentialing activities, including managing provider privileges and maintaining active affiliations.</li></ul>Collaboration &amp; Operational Support<ul><li>Work closely with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer concerns, and authorization delays.</li><li>Ensure provider data is accurate and consistent across CAQH, PECOS, NPPES, CMS databases, and internal systems.</li><li>Maintain a centralized credentialing tracker, including provider credentials, expiration dates, payer participation status, and system access information.</li><li>Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as required</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs80,000.00 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>Credentialing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Payer Enrollment & Credentialing Specialist

Standard High School & College

Job Title: Medical Billing and Credentialing Specialist Company: Deosai Medical Services Location: I-8, Islamabad (On-site) Job Type: Full-time Reports To: Medical Billing and Credentialing ManagerJob Summary:The Medical Billing and Credentialing Specialist at Deosai Medical Services is responsible for overseeing all billing processes and managing provider credentialing. The role ensures timely and accurate submission of claims to insurance companies while verifying the credentials of healthcare providers to maintain compliance with regulatory standards. This specialist will work closely with providers, insurance companies, and internal teams to optimize billing accuracy and ensure proper credentialing.Key Responsibilities:Billing:<ul><li>Submit and process medical claims to insurance companies in compliance with all regulations.</li><li>Ensure accuracy in coding (CPT, ICD-10, HCPCS), modifiers, and documentation before submission.</li><li>Follow up on denied or rejected claims and manage appeals as necessary.</li><li>Track and resolve outstanding accounts receivables.</li><li>Send out patient bills, handle inquiries, and process payments.</li><li>Maintain accurate patient and insurance records</li></ul>Credentialing:<ul><li>Manage credentialing and re-credentialing processes for healthcare providers.</li><li>Ensure all providers comply with state and federal regulations, including licenses and certifications.</li><li>Complete and submit credentialing applications to insurance carriers and healthcare organizations.</li><li>Track credentialing status and resolve any delays or discrepancies.</li><li>Maintain up-to-date provider contracts, credentialing records, and licensing.</li></ul>Compliance &amp; Reporting:<ul><li>Stay updated on billing and credentialing regulations to ensure compliance.</li><li>Generate reports on billing and credentialing activities.</li><li>Assist with internal audits to ensure adherence to best practices and regulations.</li></ul>Collaboration:<ul><li>Coordinate with healthcare providers to gather necessary documentation for billing and credentialing.</li><li>Collaborate with insurance companies to resolve claims and credentialing issues.</li><li>Work with finance and administrative teams to improve the revenue cycle.</li></ul>Qualifications:<ul><li>High school diploma or equivalent required; Associate&rsquo;s or Bachelor&rsquo;s degree in healthcare administration, business, or related field preferred.</li><li>Proficiency in the English language</li></ul>Experience:<ul><li>2+ years of experience in medical billing, coding, and credentialing.</li><li>Strong knowledge of billing practices, insurance regulations, and credentialing procedures.</li><li>Experience with medical billing software and EHR systems (e.g., Epic, Kareo, AdvancedMD).</li></ul>Skills:<ul><li>Knowledge of CPT, ICD-10, and HCPCS coding standards.</li><li>Familiarity with Medicare, Medicaid, and commercial insurance billing processes.</li><li>Strong organizational skills and attention to detail.</li><li>Excellent communication and interpersonal skills.</li><li>Ability to work independently and as part of a team.</li><li>Proficiency in Microsoft Office Suite (Excel, Word).</li></ul>Job Type: Full-timeWork Location: In person

Medical Billing and Credentialing Specialist

Jawa Health Care

Job Title: Credentialing Expert Department: Credentialing / RCM Industry: Healthcare / DME Experience: 1&ndash;3 years (Fresh + Experienced can apply)Job SummaryWe are looking for a detail-oriented Credentialing Expert to manage provider enrollment, re-credentialing, and compliance with insurance networks. The ideal candidate will ensure timely onboarding of providers and maintain accurate credentialing records.Key Responsibilities<ul><li>Handle provider enrollment with Medicare, Medicaid, and commercial payers</li><li>Manage CAQH profiles (creation, updating, attestation)</li><li>Submit and track credentialing and re-credentialing applications</li><li>Follow up with insurance companies for application status</li><li>Maintain provider documentation (licenses, NPI, DEA, malpractice insurance)</li><li>Ensure compliance with payer requirements and deadlines</li><li>Resolve credentialing-related issues and delays</li><li>Maintain accurate records in credentialing systems</li></ul>Requirements<ul><li>Bachelor&rsquo;s degree (preferred)</li><li>Knowledge of US healthcare credentialing process</li><li>Familiarity with CAQH, PECOS, NPPES</li><li>Strong communication and follow-up skills</li><li>Good command of MS Excel and documentation</li></ul><ul><li>Shift: Night shift (US timing)</li><li>6pm to 3am</li><li>Monday to Friday</li><li>Saturday Sunday off</li><li>Location: On-site</li><li>Salary: Market competitive</li><li>Perks: Growth, training,</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Credentialing Expert

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

Explore 634+ Credentialing specialist in Pakistan this May. Find roles across top companies and apply now to boost your career.

634 credentialing specialist jobs In Pakistan

Credentialing Specialist

Credentialing Specialist

Credentialing Specialist

Payer Enrollment & Credentialing Specialist

Medical Billing and Credentialing Specialist

Credentialing Expert

Credentialing Executive