medical credentialing specialist

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 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

eServMD Pvt. Ltd.

eServMD Pvt Ltd is a service provider company based in Islamabad Pakistan providing services to US-based companies and clients in the field of Electronic Medical Records (EMR), Medical Practice Management, Medical Billing, Real Estate, Accounts &amp; Finance.We are seeking experienced and detail-oriented Credentialing Executive to join our team.Primary Responsibilities:<ul><li>Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications</li><li>Maintain internal provider grid to ensure all information is accurate and logins are available</li><li>Update each provider&rsquo;s CAQH database file timely according to the schedule published by CMS</li><li>Help medical providers to apply or renewal of medical professional licenses; DEA and Controlled Substance etc.</li><li>Complete revalidation requests issued by government payers</li><li>Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid Complete re-credentialing applications for commercial payers</li><li>Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing</li><li>Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases</li></ul>Requirements<ul><li>1-2 years prior Experience in US Medical Credential</li><li>Minimum Bachelor&rsquo;s Degree in Commerce/Finance/Arts/ Pharmacy/ Microbiology or related</li><li>Excellent in English communication skills both verbal &amp; written, spoken English in American pronunciation is desired</li><li>Good Command over Excel, word and health industry related software tools</li><li>Excellent Organizational, Analytical skills and able to adapt to changing situations</li><li>Proven Knowledge of basic medical terminologies such as coding-ICD10, CPT &amp; HCPC</li><li>Experienced in Managing the Overall Revenue Cycle</li><li>Knowledge about Data Conversion and EMR implementation</li><li>Knowledge about enrollment &amp; credentialing and EDI &amp; ERA/EFT setup</li></ul>Job Timings: 5:00 PM to 2:00 AMJob Type: Full-timeAbility to commute/relocate:Job Type: Full-timeWork Location: In person

Sr. Credentialing Executive

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

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

DocGo

<div>Job Title: Coordinator, Licensing &amp; Credentialing
Location: Remote
Employment Type: Temporary, open-ended position, part-time up to 40 hours a week - some weekends and evenings needed
Hourly Rate: $20.00 - $27.00/hour, based on experience on a W2<h2 class="jobSectionHeader">
Description</h2><div>
We&rsquo;re looking for a detail-oriented Credentialing Specialist to support provider
onboarding and compliance across a multi-state telehealth environment. This role is critical to ensuring our clinicians are fully vetted, credentialed, and ready to safely deliver care.
Key Responsibilities:<ul><li>
Manage end-to-end credentialing for providers from intake through approval</li><li>
Build and maintain provider profiles in Modio</li><li>
Track workflows and progress in JIRA</li><li>
Perform primary source verification (licenses, education, board certs, DEA, etc.)</li><li>
Run sanction screenings (OIG, SAM, NPDB) and complete compliance checks</li>
Partner cross-functionally to move providers from Credentialing Approved<li> Clear to Practice (CTP)</li><li>
Communicate with providers to ensure timely application completion</li><li>
Assist with the onboarding process for new clinicians</li><li>
Manage the end-to-end medical licensing process.</li><li>
Assist with the onboarding process for new clinicians</li><li>
Ensure timely acquisition and renewal of licenses for all SteadyMD physicians and nurses.</li><li>
Maintain compliance with state and federal licensing regulations.</li><li>
Act as the primary liaison with medical boards and regulatory agencies.</li><li>
Update internal teams on changes in licensing laws and requirements.</li></ul></div><h2 class="jobSectionHeader">
Preferred Requirements</h2><div><ul><li>
2+ years of credentialing and/or licensing experience preferred (telehealth or multi-state preferred)</li><li>
Strong understanding of primary source verification &amp; compliance requirements</li><li>
Experience with credentialing platforms (Modio preferred)</li><li>
Highly organized with strong attention to detail</li><li>
Comfortable managing multiple providers and deadlines</li><li>
Excellent organizational and communication skills.</li><li>
Ability to work collaboratively with cross-functional teams.</li><li>
Working knowledge of current IMLC, FSMB, and reciprocity states</li><li>
Experience managing licensing for physicians, and nurses across all 51 states.</li></ul></div>
EEO/AAP Statement: DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position.</div>

Coordinator, Licensing & Credentialing

CHRISTUS Health

<div>Description 
CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 253-bed hospital serving the fastest-growing area of San Antonio. Specialized care includes orthopedic and surgical care with advanced spine surgery, Intensive Care, complex neurology for treating stroke and other neurovascular issues, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, women&rsquo;s services, a newborn nursery, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, emergency services, and more. The campus also boasts an Outpatient Imaging Center, an Ambulatory Surgery Center, and four medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.
Summary:
Under the direction of the Director of Medical Staff Services, the Medical Staff Coordinator Lead assures the proper credentialing of licensed independent practitioners, physician assistants, nurse practitioners, and certified registered nurse anesthetists. with medical staff privileges. Leads the administrative and documentation support to medical staff services of the facility. Validates, records, transcribes, and maintains all necessary records. Acts as a liaison between the medical staff, medical staff office and physician recruitment committee. Acts as a liaison between the medical staff and other departments of the hospital and provides direction in the coordination of the duties of the medical staff. Maintain a working knowledge of the medical staff bylaws, hospital rules and regulations and hospital policies pertaining to medical staff, practitioner and the organization to ensure the medical staff&rsquo;s adherence within stated parameters.
Responsibilities:
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
As the hospital Credentials Committee Liaison, validates the Practitioner credentialing applications for licensed independent practitioners, physician assistants, nurse practitioners, and certified registered nurse anesthetists, in accordance with accreditation standards, regulatory requirements and policies and procedures in preparation for review by the Credentials Committee.</li><li>
Leads the examination of researches, enters data, files, and gathers all information necessary to process information received from practitioners to support the credentialing process.</li><li>
Researches, develops, and revises, existing privilege sheets to assure they are most current in regard to standard of care and new technology.</li><li>
Responsible for the maintenance and accuracy of electronic credentialing files;</li><li>
Respond to telephone inquiries and written inquiries from practitioners and other departments, pertaining to practitioner and credentialing status in a professional and courteous manner.</li><li>
Facilitate all additions, terminations and changes to practitioners' membership and privileges for processing to the Board of Directors in the secure credentialing software.</li><li>
Medical Staff Organization facilitator of Medical Executive Committees per the bylaws.</li><li>
Maintain a high level of proficiency in the implementation of the medical staff database system modules related to medical staff, practitioners, and the organization to ensure the medical staff's adherence with stated parameters.</li><li>
Maintain compliance with regulatory and accrediting bodies; Joint Commission standards, State and Federal Law pertaining to the Medical Staff and apply them to the credentialing, privileging process as needed.</li><li>
Manage (FPPE) and Ongoing Professional Practice Evaluations (OPPE).</li><li>
Coordinate the Medical Staff's succession and leadership process including the election process of system hospital medical staff leadership in compliance with the medical staff bylaws processes.</li><li>
Facilitate medical staff committee meetings as requested, which includes committee notification, drafting agendas, taking and drafting minutes; and any follow up as required</li><li>
Manage the Practitioner Conduct process as needed per policy.</li><li>
Manage with onboarding process of medical staff and allied health professional candidates.</li><li>
Maintain communication boards and ER Roster or other tasks as assigned.</li></ul>
Requirements:
Education
<ul><li>Associate Degree or equivalent education and experience. Medical terminology training is preferred.</li><li>
Excellent oral and written communication skills</li><li>
Excellent interpersonal skills and work effectively and efficiently with healthcare professionals both in and out of the hospital environment</li><li>
Must be motivated as well as a self-starter who can work independently however capable and willing to take direction as appropriate</li><li>
Knowledge of medical terminology preferred</li><li>
Exhibits a high degree of confidentiality</li><li>
Must possess strong organizational skills</li><li>
Proficient computer skills to operate Microsoft Outlook, Word and Excel.</li></ul>
Experience 
<ul><li>Five (5) years' experience in healthcare</li><li>
A minimum of three (3) years in credentialing physician and allied health professionals</li></ul>
Licenses, Registrations, or Certifications
<ul><li>CPCS (Certified Professional Credentialing Specialist) or CPMSM (Certified Professional Medical Staff Management Certification preferred</li></ul>
Work Schedule: 
5 Days - 8 Hours
Work Type:
Full Time</div>

Coordinator Medical Staff Lead - Med Staff Administration

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

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