credentialing specialist

EdSavvy Solutions

Job Title: Credentialing SpecialistCompany: Edsavvy Solutions Location: Lahore (Near UCP) Shift Timing: 5:00 PM &ndash; 2:00 AM Job Type: Full-timeAbout Us: Edsavvy Solutions is a Lahore-based medical billing company providing services to clients in the United States. We are seeking a detail-oriented and motivated Credentialing Specialist to join our growing team.Job Responsibilities:<ul><li>Manage provider credentialing and re-credentialing processes</li><li>Prepare and submit credentialing applications to insurance panels</li><li>Maintain accurate provider records and documentation</li><li>Follow up with insurance companies regarding application status</li><li>Ensure compliance with industry standards and client requirements</li></ul>Key Requirements:<ul><li>6 months to 2 years of experience in credentialing</li><li>Experience in dental credentialing can be considered</li><li>Strong attention to detail and organizational skills</li><li>Willingness to work in the night shift (5:00 PM &ndash; 2:00 AM)</li></ul>What We Offer:<ul><li>Professional work environment</li><li>Growth and career development opportunities</li><li>Exposure to international clients</li></ul>How to Apply: Interested candidates are encouraged to send their resumes to: Email: hr@edsavvysolutions.comPay: Rs50,000.00 - Rs100,000.00 per monthWork Location: In person

Credentialing Specialist

The Garden of Eve

Job Title:Credentialing SpecialistWho We Are7 KINGS CODE is US based Software solutions company. We support our partners and clients globally in USA, CANADA, EUROPE, INDIA, PAKISTAN &amp; MIDDLE EAST.Education &amp; Experience Required:<ul><li>Bachelor&rsquo;s degree in healthcare administration, business, or a related field preferred. Equivalent experience may be considered.</li><li>4+ years of experience in credentialing, enrolment, or related roles in the medical billing industry.</li></ul>Skills Required:<ul><li>Solid experience in credentialing of Clinics and Labs</li><li>Familiarity with Medicare, Medicaid, and commercial payer enrolment processes.</li><li>Proficiency in credentialing software and tools (e.g., CAQH ProView, PECOS).</li><li>Strong knowledge of medical billing processes and insurance verification.</li><li>Familiarity with HIPAA and other healthcare regulations.</li></ul>Job Location: Onsite, DHA Phase 8 - Ex Park View, Lahore.Job Timings: PAK TIME: 5:30PM to 02:30AMApply with your latest cv at: hr@7kingscode.comJob Type: Full-timeAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Education:<ul><li>Bachelor's (Required)</li></ul>Experience:<ul><li>Credentialing of Clinics and Labs: 4 years (Required)</li></ul>Work Location: In personJob Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthWork Location: In person

Credentialing & Enrollment specialist

Macrise Tech Solutions

The Credentialing Specialist is responsible for managing the end-to-end credentialing and re-credentialing process for healthcare providers across multiple insurance networks, payers, and credentialing platforms. This role requires a proactive professional with strong attention to detail and excellent follow-up skills to ensure ongoing regulatory compliance, uninterrupted provider participation, and efficient billing and authorization workflows. The position plays a key role in maintaining operational continuity and supporting accurate reimbursement processes.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Maintain, organize, and regularly update provider credentialing records for both commercial and government payers.</li><li>Manage and monitor CAQH profiles to ensure compliance with CMS regulations and payer-specific credentialing requirements.</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 required provider revalidation processes with government and regulatory agencies within established timelines.</li><li>Coordinate hospital credentialing activities, including provider privileges and maintaining active hospital affiliations.</li></ul>Collaboration &amp; Operational Support<ul><li>Work closely with the Revenue Cycle Director and Billing Team to address credentialing-related denials, payer issues, and authorization delays.</li><li>Ensure provider information is accurate and consistent across CAQH, PECOS, NPPES, CMS databases, and internal credentialing 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 - 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

Credentialing Executive-Medical Billing

Revmed

Job Summary:We are seeking a detail-oriented and experienced Medical Credentialing &amp; Enrollment Specialist to manage provider credentialing, re-credentialing, and payer enrollment processes. The ideal candidate will ensure compliance with insurance and regulatory requirements while maintaining accurate provider records and timely submissions.Key Responsibilities:<ul><li>Manage end-to-end provider credentialing and enrollment with insurance payers (Medicare, Medicaid, Commercial Plans).</li><li>Prepare and submit initial credentialing and re-credentialing applications.</li><li>Maintain and update provider information in CAQH (Council for Affordable Quality Healthcare).</li><li>Track application status and follow up with payers to ensure timely approvals.</li><li>Handle provider enrollment, revalidation, and demographic updates.</li><li>Maintain accurate records of provider credentials, licenses, certifications, and expirations.</li><li>Coordinate with internal departments (billing, HR, compliance) for required documentation.</li><li>Resolve credentialing-related issues and payer denials.</li><li>Ensure compliance with healthcare regulations and payer requirements.</li><li>Maintain credentialing database and prepare reports as required.</li></ul>Requirements:<ul><li>Bachelor&rsquo;s degree or relevant experience in Healthcare Administration or related field.</li><li>1&ndash;3+ years of experience in US medical credentialing and enrollment.</li><li>Hands-on experience with CAQH, PECOS, NPPES, and payer portals.</li><li>Strong knowledge of Medicare, Medicaid, and commercial insurance processes.</li><li>Excellent communication and follow-up skills.</li><li>Strong attention to detail and organizational skills.</li><li>Ability to handle multiple providers and deadlines simultaneously.</li></ul>Preferred Skills:<ul><li>Experience in RCM (Revenue Cycle Management) environment.</li><li>Familiarity with credentialing software/tools.</li><li>Knowledge of compliance and healthcare regulations.</li><li>Ability to work independently and in a team environment.</li></ul>Benefits (Customize as per your company):<ul><li>Competitive Salary Package</li><li>Post-Probation &amp; Annual Increments</li><li>Family Health Insurance</li><li>Paid Leaves &amp; Leave Encashment</li><li>Performance &amp; Retention Bonuses</li><li>Meal Allowance</li><li>Pick &amp; Drop (for female staff)</li></ul>Job Type: Full-timeWork Location: In person

Medical Credentialing & Enrollment Specialists

Boston Children's Hospital

<div><div><div><div>84278BR</div>
</div><div><div>Medical Staff Services</div>
</div><div>Job Posting Description
<div>Coordinates and supports the Medical Staff Credentialing Specialists with the Medical Staff and House Staff credentialing processes. Processes initial and reappointment applications by tracking due dates, monitoring email, and routing documentation to the Specialist in accordance with policies and procedures, Joint Commission standards, National Commission for Quality Assurance (NCQA) standards, state and federal regulations, and Boston Children&rsquo;s Hospital Medical Staff Bylaws and Rules and Regulations. Maintains paper and electronic confidential credentialing files for all members of the Medical Staff and House Staff. Generates standard or routine reports using the medical staff software database program. Creates and produces diplomas for House Staff Training Programs. Processes initial and renewal of Massachusetts Limited Medical Licenses in the BORIM online system as the Boston Children&rsquo;s Hospital Designated Official for the Board of Registration in Medicine (BORIM) in accordance with the BORIM licensing requirements for trainees. Vets the Affiliating House Staff (Rotators). Ensures affiliated house staff documentation is complete and processed according to established processes in a timely and efficient manner. Coordinates completion of documentation with departments and divisions, Human Resources, and other key stakeholders. Tracks the expiring document process, including Medical Licenses, Federal Drug Enforcement Agency (DEA) certification, Massachusetts Controlled Substances Registrations, and malpractice face sheets. Communicates with clinicians and escalates concerns regarding potentially expiring documentation in an accurate and timely manner. Assists the Manager of the Medical Staff Office as the primary liaison for the Risk Management Foundation by maintaining and enrolling Medical Staff and House Staff members in the Controlled Risk Insurance Company (CRICO) medical malpractice program. Provides general administrative support to office. Schedules appointments and meetings. Answers, screens, and routes telephone calls. Maintains administrative program files and records. Prepares, routes, and tracks forms and documents. Prepares monthly deposits and assists in tracking receipt of associated credentialing fees. Creates a customer-friendly and healthy work environment in support of employee engagement and well-being. Assists in facilitating an efficient, productive, accountable, and customer and quality-oriented work environment using high-reliability principles. Provides and ensures the highest level of service to all customers (internal and external) as demonstrated through the core values of the enterprise.</div>
</div><div>Status
<div>Full-Time</div>
</div><div>Regular, Temporary, Per Diem
<div>Regular
</div></div><div>Standard Hours per Week
<div>40
</div></div><div>Pay Range
<div>$19.06-$27.64 Hourly</div>
</div><div>Office/Site Location
<div>Boston</div>
</div><div>Job Posting Category
<div>Support Services</div>
</div><div>Remote Eligibility
<div>Part Remote/Hybrid</div></div></div></div><div></div>

Credentialing Assistant

Molina Healthcare

Job Summary
 
Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.
 
Job Duties
 
Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.
 
Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.
 
Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.
 
JOB QUALIFICATIONS
 
Required Education: High School Diploma or GED.
 
Required Experience/Knowledge Skills & Abilities
 
<ul>
<li>Experience in a production or administrative role requiring self-direction and critical thinking.</li>
<li>Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.</li>
<li>Experience with professional written and verbal communication.</li>
</ul>
Preferred Experience: 
<ul>
<li>Experience in the health care industry</li>
<li>Experiece with Provider credentialling</li>
</ul>
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
 Pay Range: $22.36 - $34.88 / HOURLY
 <ul>
<li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.</li>
</ul>

Assoc Specialist, National Credentialing (Provider Credentialing) Remote

CHRISTUS Health

<div>Description 
Summary:
Assures the proper credentialing of physicians, professionals, and paraprofessional individuals with staff privileges. Provides administrative and secretarial support to the medical staff. Records, transcribes, and maintains all necessary records.
Responsibilities:
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
The Credentials Verifications Office (CVO) Medical Staff Coordinator is responsible for the coordination of medical Staff credentialing and privileging.</li><li>
The CVO Medical Staff Coordinator prioritizes the work processes and monitors the performance of the Credentialing Specialist</li><li>
Process and expedite the CVO credentialing of Medical Staff and Allied Health Professional applications, appointments, reappointments, requests for change in privileges, and changes in status.</li><li>
Maintain credentials files, reflecting current licensure, liability insurance, board certification, etc.</li><li>
Maintain current data in credentialing software system for easy and accurate access upon request.</li><li>
Prepare reports from credentialing software as requested.</li><li>
Act as liaison to all members of the Medical Staff by handling telephone and written requests for verification information.</li><li>
Other duties as assigned.</li></ul>
Requirements:
Education/Skills
<ul><li>High School Diploma or equivalent</li></ul>
Experience 
<ul><li>1-3 years&rsquo; experience preferred</li></ul>
Licenses, Registrations, or Certifications 
<ul><li>Certified Provider Credentialing Specialist (CPCS) certification within 2 years of hire.</li></ul>
Work Schedule: 
8AM - 5PM Monday-Friday
Work Type:
Full Time</div>

Coordinator Medical Staff - Med Staff Administration - Full Time

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