credentialing specialist

Obizworks-Offshore Business Consultants

Job Title: Credential Specialist &amp; Data AnalystLocation: Remote (Pakistan) &ndash; Night Shift (U.S. Business Hours)About the Role: We are hiring a Provider Data Management Analyst to support U.S.-based dental practices in managing provider data and insurance carrier applications. This role requires strong attention to detail, good communication skills, and the ability to work confidently with SaaS platforms. You will coordinate directly with dental providers and insurance carriers while ensuring accuracy and timely completion of applications.Key Responsibilities:<ul><li>Manage and update provider information using SaaS tools (training will be provided).</li><li>Review, complete, and proofread insurance applications for credentialing and re-credentialing.</li><li>Communicate with dental providers and insurance carriers by phone and email to collect or verify information.</li><li>Track application status and follow up to ensure timely processing.</li><li>Maintain accuracy and consistency of data across all records.</li></ul>Requirements:<ul><li>Bachelor&rsquo;s degree (BBA, Healthcare Management, IT/Computer Science, or related field).</li><li>2&ndash;5 years of relevant experience in data management, healthcare, insurance, or administration.</li><li>Strong English communication skills (verbal and written).</li><li>Ability to work independently with attention to detail.</li><li>Comfortable working during U.S. business hours (night shift in Pakistan).</li><li>Experience with healthcare/dental credentialing processes is a plus.</li></ul>Salary Range: PKR 80,000 &ndash; 150,000 per month (based on experience).Why Join Us:<ul><li>Opportunity to work with a U.S.-based company.</li><li>Professional growth in healthcare and IT-enabled services.</li><li>Collaborative and supportive work environment.</li></ul>Do Not Apply If:<ul><li>You are not willing to work night shift (U.S. hours).</li><li>Your English communication is weak.</li><li>You do not have relevant experience in data management, healthcare, insurance, or administration.</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthApplication Question(s):<ul><li>Do you have at least 2 years of experience managing and updating data using software tools ( SaaS ) ?</li><li>Do you have experience to maintain accuracy and consistency in data management?</li><li>Do you have prior experience to review and proofread insurance applications for credentialing and re-credentialing in any US Or UK dental or medical fields ?</li></ul>Education:<ul><li>Bachelor's (Required)</li></ul>Experience:<ul><li>work: 3 years (Required)</li></ul>Language:<ul><li>How would you rate your English communication skills? (Required)</li></ul>Work Location: Remote

Credentialing Specialist & RCM Specialist ( Remote )

BLSMedicalBilling

The Credentialing Specialist is primarily responsible for managing all facets of the healthcare provider credentialing, re-credentialing, privileging, and payer enrollment processes. This role ensures that all providers are properly vetted, authorized to practice, and successfully enrolled with insurance payers to facilitate timely reimbursement, with secondary duties supporting Accounts Receivable functions.Primary Duties and Responsibilities: Credentialing<ul><li>Initial Credentialing &amp; Reappointment: Manage the complete credentialing lifecycle for all practitioners, including initial applications and timely reappointment/re-credentialing.</li><li>Collect, organize, and thoroughly review all required documents (licenses, certifications, education, malpractice history, etc.).</li><li>Perform Primary Source Verification (PSV) of all credentials according to delegated and internal policies.</li><li>Payer Enrollment &amp; Maintenance:</li><li>Prepare, submit, and diligently track provider enrollment applications (initial setup, changes, terminations) with Medicare, Medicaid, and all commercial insurance carriers.</li><li>Ensure NPI, CAQH, PECOS, and state enrollment profiles are accurate, current, and attested to promptly.</li><li>Database Management: Accurately enter and maintain all provider credentialing, privileging, and payer enrollment data in the credentialing software (e.g., Cactus, MD-Staff, Symplr).</li><li>Compliance &amp; Audits:</li><li>Maintain current knowledge of state/federal regulations, medical staff bylaws, and accreditation standards (e.g., NCQA, TJC) related to credentialing and provider enrollment.</li><li>Assist in preparing for and participating in external payer or accreditation audits.</li><li>Expirables Management: Proactively monitor and track all provider expiration dates (licenses, DEA, certifications, insurance), ensuring timely renewal processes are initiated to prevent lapses in coverage or billing capacity.</li><li>Committee Support: Prepare files and relevant documentation for Credentialing Committee review and meetings.</li></ul>Secondary Duties: AR Support<ul><li>Payer Communication: Serve as a liaison between the revenue cycle team and insurance payers regarding provider enrollment issues that impact claim processing.</li><li>Denial Resolution: Assist the billing team by quickly resolving claim denials or rejections directly tied to credentialing or provider enrollment errors (e.g., &quot;provider not on file,&quot; &quot;invalid provider number&quot;).</li><li>Data Integrity: Verify that provider demographic information is consistent across the credentialing system, billing system, and payer enrollment portals.</li></ul>Qualifications and SkillsRequired Skills<ul><li>Expert Knowledge: Deep, working knowledge of the credentialing process, PSV requirements, and payer enrollment procedures.</li><li>Technology: Proficient in using specialized credentialing software (required) and familiarity with electronic health record (EHR) and medical billing systems (preferred).</li><li>Compliance &amp; Detail: Exceptional organizational skills and meticulous attention to detail to handle highly sensitive and regulated documentation.</li><li>Interpersonal Skills: Professional and effective communication skills to interact with providers, internal leadership, and external payer contacts.</li></ul>Education and Experience<ul><li>Minimum of 1 to 3 years of dedicated experience in healthcare provider credentialing, preferably in a group practice, hospital, or managed care setting.</li><li>Associate's or Bachelor's degree in Healthcare Administration or a related field is preferred.</li><li>Certification (Highly Preferred): Certified Provider Credentialing Specialist (CPCS).</li></ul>Job Type: Full-timePay: Rs35,000.00 - Rs55,000.00 per monthExperience:<ul><li>credentialing: 1 year (Preferred)</li></ul>Work Location: In person

Medical Billing Credentialing Specialist with AR Support

FNA Truck Dispatch

We are looking for a Credentialing Executive to oversee all aspects of credentialing processes within our organization. The successful candidate will be responsible for ensuring that our network of healthcare providers meets all regulatory and compliance requirements, as well as maintaining relationships with insurance carriers and managing the credentialing team.Responsibilities:&middot; Develop and implement credentialing policies and procedures to ensure compliance with industry standards and regulations.&middot; Oversee the credentialing process for healthcare providers, including initial credentialing, re-credentialing, and privileging.&middot; Maintain relationships with insurance carriers and negotiate contracts and reimbursement rates.&middot; Monitor and track credentialing activities to ensure timely completion and accuracy of credentialing files.&middot; Provide leadership and guidance to the credentialing team, including training and development opportunities.&middot; Stay abreast of changes in healthcare regulations and industry standards related to credentialing and make recommendations for process improvements.&middot; Collaborate with other departments, such as provider relations and network management, to ensure seamless integration of credentialing processes.Qualifications:&middot; Bachelor's degree in healthcare administration, business administration, or related field; Master's degree preferred.&middot; Minimum of 1 year of experience in healthcare credentialing.&middot; In-depth knowledge of credentialing processes, regulations, and accreditation standards.&middot; Strong analytical and problem-solving skills with attention to detail.&middot; Excellent communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.&middot; Proficiency in Microsoft Office Suite and credentialing software.&middot; Certification in Healthcare Credentialing (e.g., CPCS, CPMSM) preferred.Perks:&middot; Annual increments.&middot; Annual dinner.&middot; Annual tour.&middot; Employee of the month.&middot; Promotional bonuses.How to Apply: Interested candidates should submit a resume and cover letter outlining their qualifications and experience related to the position. Please include &quot;Credentialing Executive&quot; in the subject line of the email.faizahrmanager@gmail.comSalary: Market competitiveLocation: Gulberg II Opposite to Forces Academy LahoreAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Shift availability:<ul><li>Night Shift (ONLY)</li><li>ON-SITE</li></ul>Ability to Relocate:<ul><li>Lahore: Relocate before starting work (Required)</li></ul>Job Type: Full-timeWork Location: In person

Credentialing Executive

Ministry of Public Health - Qatar

<div>
 
 
 Job Summary
 
 
 
 The job holder shall verify credential documents for HR law new joiners, promotion, redesignation cases as well as review the contracts and support the licensing requirements as and when needed
 
 
 
 Key Roles and Responsibilities
 
 
 
 1. Facilitate the effective implementation of activities related to verification of professional education, experience, license for professionals seeking employment at MOPH under HR Law.
 
 
 2. Apply Verification of Credentials policy, methods and tools in day-to-day business situation.
 
 
 3. Ensure the timely submission of validated verification documents to related sections within Human Resource Department
 
 
 4. Responsible for updating the information / credentials documents of each individual in relation to their professional qualifications and Licensing/experiences as per the requirements.
 
 
 5. Assist in the development of related policies and procedures and provide interpretation to staff
 
 
 6. Ensure the compliance with policies and procedures and ensure work exactness and completeness.
 
 
 7. Review the contracts and support internal recruitment process
 
 
 8. Serve as the main point of contact for credentialing-related inquiries from employees and management.
 
 
 9. Generate reports and analytics on credentialing status, compliance rates, and other relevant metrics.
 
 
 10. Work with different HR teams to take part in various HR projects and continuous improvement initiatives
 
 
 11. Assist in the rollout and implementation of HR programs
 
 
 12. Maintain up-to-date credentialing files, ensuring compliance with internal and external regulations.
 
 
 13. Support audits by preparing documentation and responding to audit inquiries.
 
 
 14. Identify opportunities to enhance the efficiency and accuracy of the credentialing process.
 
 
 15. Implement best practices and leverage technology to automate and streamline credentialing workflows.
 
 
 16. Stay current on industry trends, regulatory changes, and best practices related to credentialing.
 
 
 17. Perform other duties as requested to meet the ongoing organizational needs.
 
 
 
 Essential Education
 
 
 
 Bachelor&rsquo;s degree in human resources, Business Administration, or a related field
 
 
 
 Required Certification/ Licensure:
 
 
 
 CIPD or SHRM
 
 
 
 Essential Experience
 
 
 
 Minimum of 12 years of HR related experience is required at a managerial level.
 
</div>

Specialist, Workforce Credentialing

Christus Health

Description Summary:The Coordinator Credentialing Senior serves as the first line of defense through the functions of providing for adequate and qualified staff. Under supervision of leadership, the Coordinator Credentialing Senior is responsible for the department. Duties include ensuring compliance with regulatory and accrediting agencies, interpreting standards, and identifying, recommending and implementing changes. This position serves as the liaison between administration and staff on matters such as medical staff credentialing. This includes, but is not limited to, verification of education and training, certification and clinical practice credentials. The Coordinator Credentialing Senior demonstrates leadership through the role of advisor to staff and administration in understanding and applying standards. This position is responsible for developing and maintaining all aspects of the credentialing function. Incumbent will demonstrate broad knowledge of the business and leadership ability to warrant role model status to others with relevant roles within the organization. The Coordinator Credentialing Senior is able to advise the medical staff leadership on matters of priority in an expeditious manner and can instruct them in the responsibilities of their positions with respect to credentialing and help bring them up to date on current issues involving regulatory agencies, clinical privileges, or standards of care. Must demonstrate sufficient empowerment skills to successfully assume and maintain at least one major project as assigned by administration. Assigned projects are strategic in nature and long term in responsibilities. The Credentialing Coordinator Senior should demonstrate strong organizational skills and assertiveness in problem solving.Responsibilities:<ul><li>Responsible for all aspects of credentialing</li><li>Serves as role model and mentor to others in interfacing relevant roles</li><li>Preceptor to others in duties related to credentialing</li><li>Cross trains other staff for major job responsibilities as appropriate for optimum functioning</li><li>Serves as liaison between staff and administration</li><li>Oversees credentialing activities</li><li>Precepts and mentors designated staff personnel</li><li>Coordinates staff with regulators</li><li>May facilitate staff meetings</li><li>May be responsible for the preparation of meetings, including production of agenda, documents for review and for personal review and preparation of staff in advance, as needed to facilitate informed participation.</li><li>May be responsible for accurate and timely recording of meeting minutes.</li><li>Assists staff in enforcing bylaws, rules and regulations, policies and procedures, and identifies /communicates the need for revisions and additions.</li><li>Tracks current licensure required for staff.</li><li>May record and track meeting attendance as required by staff bylaws for maintaining staff status.</li><li>May provide support for staff and administration for Due Process Proceedings by attending hearings and appeals meetings and recording proceedings.</li><li>Tracks monitoring/proctoring documentation necessary for the granting of special or new privileges to staff.</li><li>Updates the database for the credentials, and keeps computer system current.</li><li>May help coordinate staff functions</li><li>Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Protected Health Information ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).</li><li>Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals.</li><li>Responsible for all aspects of compliance with the standards of credentialing and accrediting bodies.</li><li>Communication, Coordination, Collaboration with all customers, internal and external</li><li>Responsible for at least one major project that contributes to the strategic initiatives of the department.</li><li>Serves as Liaison to staff in matters of credentialing and related issues.</li><li>Manages projects and timelines to achieve highest quality work within allotted period.</li></ul>Requirements:<ul><li>High School Diploma Required</li><li>3 Years Related Experience Preferred</li><li>Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator (CMSC) Preferred</li></ul>Work Schedule: 5 Days - 8 HoursWork Type: Full Time

Coordinator Credentialing Senior - Credentialing

Description Summary:Responsible for coordination and oversight of the Medical Staff Services Department, including physician and allied health credentialing and re-credentialing and privileging, organizing and minutes taking at medical staff meetings, flow of information from medical staff committees through Administration, Medical Executive Committee, and the Governing Board. Assists with TJC survey preparation for the medical staff/leadership functions, including staff and medical staff education regarding accreditation standards. Works closely with medical staff leaders, hospital administration, and Risk Manager regarding medical staff and bylaws issues.Responsibilities:• The Credentials Verifications Office (CVO) medical Staff Coordinator is responsible for the coordination of medical Staff credentialing and privileging • The CVO Medical Staff Coordinator prioritizes the work processes and monitors the performance of the Credentialing SpecialistRequirements:<ul><li>Basic Computer Knowledge</li><li>Ability to communicate effectively, both verbally and written.</li><li>Must possess strong management, organization, communication, and computer skills; must demonstrate good interpersonal and analytical skills and the ability to work under stress and maintain confidentiality.</li><li>Requires a minimum of 3-5 years' experience in a medical staff office or related health care environment and has effective knowledge of TJC and TDH Standards.</li><li>High school diploma or equivalent.</li></ul>Work Schedule: 8AM - 5PM Monday-FridayWork Type: Full Time

Coordinator Medical Staff-Med Staff Administration-Full Time

Serve the People Community Health Center

<div>Description:

The Human Resources Generalist plays a dual role in ensuring the effectiveness of credentialing processes for healthcare professionals and providing key support to human resources functions. This role requires a highly organized, detail-oriented professional capable of managing credentialing tasks, employee onboarding, and HR compliance. The ideal candidate will balance independent responsibilities with team collaboration to uphold organizational standards and regulatory compliance. The following statements for this position reflect only some specific responsibilities and are considered necessary to describe the principal functions of the job as identified and shall not be considered a detailed description of all duties required that may be inherent in the position:<ul><li>
Manage job postings and coordinate recruitment efforts to attract and hire qualified candidates.</li><li>
Facilitate new employee orientation and onboarding processes to ensure seamless integration into the organization.</li><li>
Conduct background checks and pre-employment screenings.</li><li>
Serve as a point of contact for employee questions, concerns, and grievances, promoting resolution through appropriate channels.</li><li>
Administer and document progressive disciplinary actions, including verbal and written warnings, to address performance or behavioral concerns.</li><li>
Guide management on employee write-ups, ensuring documentation adheres to legal standards and organizational policies.</li><li>
Assist with the preparation and facilitation of employee dismissals, ensuring compliance with regulations and maintaining professionalism during the process.</li><li>
Foster a positive work environment by mediating conflicts and ensuring adherence to organizational policies.</li><li>
Ensure compliance with federal, state, and local labor laws, including wage and hour regulations and EEO requirements.</li><li>
Assist in developing and updating HR policies and employee handbooks.</li><li>
Support employees with benefits enrollment and questions.</li><li>
Administer leave programs, including FMLA, worker's compensation, and other absence management policies.</li><li>
Assist employees in 403(b) retirement plan enrollment, insurance selections, and reviewing benefit options to ensure understanding and informed decision-making.</li><li>
Learn and maintain proficiency in the HRIS system, Paylocity, to manage employee data, process updates, and generate accurate HR reports.</li><li>
Assist in tracking, scheduling, and distributing employee evaluations, including 90-day and annual performance evaluations, ensuring timely completion and documentation.</li><li>
Assist in overseeing credentialing documentation to ensure all records are accurately maintained within the credentialing platform, and troubleshoot credentialing discrepancies or occurrences as needed to support compliance and operational efficiency.</li><li>
Coordinate and deliver employee training programs focused on compliance, professional development, and organizational values.</li><li>
Support leadership in succession planning and workforce development initiatives.</li><li>
Maintain accurate and confidential employee records in compliance with legal standards.</li><li>
Generate reports and track metrics related to HR activities, including turnover and recruitment performance.</li><li>
Assist with payroll and HRIS data entry as needed.</li><li>
Perform other related tasks as required to support organizational goals.</li><li>
Adhere to HIPAA regulations and other relevant laws to protect patient privacy and confidentiality in all communications.</li><li>
Perform other duties as assigned by the executive leadership and administration.</li></ul>
Requirements:
<ul><li>Bachelor&rsquo;s degree in Human Resources, Business Administration, or a related field preferred; equivalent experience may be considered.</li><li>
2-3 years of HR experience, preferably in a healthcare or non-profit setting.</li><li>
Knowledge of labor laws and best practices in HR management.</li><li>
Thorough understanding of relevant state and federal regulations, including but not limited to CMS, Joint Commission, and HRSA requirements.</li><li>
High level of attention to detail and accuracy, particularly in documentation, compliance checks, etc.</li><li>
Excellent verbal and written communication skills to effectively interact with healthcare providers, and administrative staff.</li><li>
Strong organizational and time-management skills.</li><li>
Commitment to ongoing education and professional growth in the field of credentialing and healthcare compliance.</li></ul></div>

Human Resources Generalist

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