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credentialing team lead

Speak Viral

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(7pm to 4am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Credentialing Team Lead

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

Meds IT Nexus

Job descriptionJob descriptionMeds Nexus is looking for candidates on the night shift with experience as Team Lead Credentialing &amp; EDI. The candidate should be enthusiastic and must have a proven work experience in performing all New Client Account Setups, Research and Development activities, ensuring that the credentialing requirements for government and commercial payers are met, Submit and follow-up on submitted credentialing requests to all contracted commercial payers and government agencies, maintain the close working relations experience will be preferred along with Basic IT skills (databases, MS Office, etc.)Job Responsibilities:3 to 5 years of experience in credentialing departmentAt least 1 year of experience in a Supervisory RoleExperience in credentialing different specialties with major regular and private payers state-wiseReview the approval and termination of professional provider contracts as they relate to the credentialing processEnsure accurate and timely information for re-credentialing, data analysis, and directory generation, as well as recommending changes to the credentialing criteria and processesMaintain all credentialing and re-credentialing policies and processes to ensure that they comply with all applicable regulationsDevelop and implement departmental goals and objectives with input from staff membersDevelop and implement departmental policies and procedures that guide and support the provision of servicesInteract with all customers to ensure prompt and accurate communication as needed to provide the service expected and to meet the goals of the service.Job Types: Contract, Full-timeContract length: 36 month<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Credentialing &amp; Enrollment + EDI: 5+ years (Preferred)</li></ul>Language:<ul><li>Fluent English (Preferred)</li></ul>Job Type: Full-timeAbility to Relocate:<ul><li>Rawalpindi: Relocate before starting work (Required)</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthWork Location: In person

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(7pm to 4am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Credentialing Specialist

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

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 night shift(7pm to 4am)?</li><li>Will you be able to commute to Bahria Town Phase 7 Rawalpindi?</li></ul>Work Location: In person

Credentialing Executive

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

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