physician credentialing specialist

Round Table Medical Consultants LLC

<div>The Credentialing/Contracting Specialist will be responsible for all tasks associated with physician privileging and medical staff membership credentialing. The Specialist will communicate with outside agencies, including physician offices, hospitals, insurance carriers, and other healthcare agencies as required.
<ul><li>Minimum Education: High School Diploma/G.E.D.
</li><li>Minimum 3+ years of experience with physician and facility credentialing is required.
</li><li>Experience with insurance carrier credentialing preferred</li><li>
Maintain strong skills in diplomacy, professionalism, and trustworthiness.
</li><li>Strong communication skills in both oral and written.
</li><li>Positive attitude, Team Player, and ability to work independently.
</li><li>Knowledge of EPower and Centricity is a benefit.</li><li>
Strong working knowledge of computers and Windows PC applications, such as Excel and Word, including the ability to learn new computer systems and applications.</li><li>
Ability to manage multiple priorities and projects.
</li><li>Detail-oriented with a desire to produce work with 100% accuracy.
</li><li>Excellent analytical and problem-solving skills.</li></ul>
JOB RESPONSIBILITIES/ DUTIES<ul><li>
Responsible for internal credentialing of all providers in the practices and external consultants coming to the practices.
</li><li>Responsible for credentialing facilities with insurance carriers.
</li><li>Responsible for maintaining complete and up-to-date credentialing files for each provider and every practice to internal defined standards.
</li><li>Meets with providers to gather, review, and provide guidance on completion of credentialing packets.
</li><li>Coordinates the accurate input of physician information into CAQH, Medicare, Medicaid, and the internal tracking database.</li><li>
Responsible for the processing of accurate completion of Texas Standardized Credentialing Applications in MS Word files for each physician.
</li><li>Responsible for the input of physician documents into the database and the proper maintenance of all necessary documents mandated by the organization.
</li><li>Continuously verifies the status of CVs, provider licenses, DEA, DPS certificates, and specialty certificates; alerts leadership on any expirables not obtained and any provider who is not responding to open requests.</li><li>
Continuously tracks renewals of provider licenses, DEA, DPS, and ACLS certificates.
</li><li>Maintains record-keeping on providers&rsquo; CMEs and follows up with them to receive the CMEs they have completed.</li><li>
Ensures providers&rsquo; information is forwarded to the appropriate channels within the organization on a mandated basis.</li><li>
Completes various provider applications and tracks the status of applications once submitted to all insurance carriers.</li><li>
Maintains Contact information and provides it to leadership upon hiring of new providers and completion of the credentialing process.</li><li>
Updates the appropriate departments on the status of providers&rsquo; credentialing on Managed Care/Insurances.</li><li>
Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.</li><li>
Perform other duties as assigned by the Director of Operations as necessary.
</li></ul>WORKING CONDITIONS
<ul><li>The employee will be exposed to working conditions commensurate with a traditional office environment.</li><li>
The employee must be able to lift and/or move using proper body mechanics and agree to ask for assistance if required.</li><li>
While performing the duties of this job, the employee is frequently required to stand, walk, and sit.</li><li>
Must submit to random drug screenings.</li></ul>
Full-Time Benefit Perks:<ul><li>
Health benefits start on the first of the month after hire</li><li>
Medical, dental, and vision plans with sliding-scale premiums</li><li>
100% coverage for preventive health services</li><li>
HSA and FSA options available</li><li>
Company-paid life insurance and long-term disability</li><li>
401(k) with contributions starting after 30 days</li><li>
100% match on the first 4%,
</li><li>Full vesting after 3 years</li><li>
Access to exclusive employee discounts on travel, fitness, shopping, and more</li><li>
Paid Time Off</li><li>
Paid Holiday</li></ul>
Join us and make a significant impact on our company&rsquo;s success in reaching our target audience and driving business growth.</div>

CREDENTIALING SPECIALIST

Behavioral Health Group

<div>Remote Position - Requires Payor Credentialing and Payor Enrollment experience

The Payor Credentialing Specialist is responsible for leading, coordinating, monitoring, and maintaining the payor and provider credentialing and re-credentialing processes. Facilitates all aspects of BHG&rsquo;s payor credentialing including payor enrollments, revalidations, maintenance, license updates, and follow up on payor credentialing related A/R issues. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to payor credentialing and enrollment. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director of Payor Credentialing in conjunction with Chief Revenue Officer.

The key responsibilities of the Payor Credentialing Specialist include but not limited to:

Duties and Responsibilities
<ul>
<li>Prompt and regular attendance at an assigned work location.</li>
<li>Ability to complete or oversee the completion of assigned tasks/projects in a timely manner.</li>
<li>Complete process to enroll and credential facilities as well as providers with insurances; ensure all payor criteria are met.</li>
<li>Leads, coordinates, and monitors the collection, review, and analysis of payor enrollment applications.</li>
<li>Responsible for accuracy and completeness of payor enrollment submissions including supporting documentation.</li>
<li>Follow up with providers and insurances for timely credentialing and enrollment process(es).</li>
<li>Responsible for monitoring application progress and following up with payors as needed until confirmation of credentialing and network load is complete.</li>
<li>Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.</li>
<li>Review, and update if necessary; health plan directories, agencies, and other appropriate entities for current and accurate provider information</li>
<li>Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and enrollment issues as they arise.</li>
<li>Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation.</li>
<li>Enters and maintains accuracy of data input into Credential Stream, PECOS, NPPES, CAQH, Optum, Availity, and other payor portals.</li>
<li>Verify provider accuracy in payor directories.</li>
<li>Provide support with managed care delegated credentialing audits; conduct internal file audits.</li>
</ul>
Regulatory
<ul>
<li>Ensure compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state laws) and policies and procedures in all aspects of the payor credentialing process.</li>
</ul>
Marketing and Outreach
<ul>
<li>Participate in community and public relations activities as assigned.</li>
</ul>
Professional Development
<ul>
<li>Demonstrates the belief that addiction is a brain disease, not a moral failing.</li>
<li>Demonstrates hope, respect, and caring in all interactions with patients and fellow team members.</li>
<li>Establishes and maintains positive, professional relationships in the workplace.</li>
<li>Ability to work independently and under deadlines while handling multiple tasks simultaneously.</li>
<li>Makes decisions and uses good judgment with confidential and sensitive issues.</li>
<li>Maintain professional, calm demeanor with others in stressful or other undesirable situations.</li>
</ul>
Training
<ul>
<li>Attend and complete all required trainings as assigned by Director.</li>
<li>Prompt and regular attendance at an assigned work location.</li></ul> 


Minimum Requirements
<ul><li>The Credentialing Administrator needs at least 3 to 5 years of experience in payor credentialing/enrollment experience.</li>
</ul>
Qualifications
<ul>
<li>Bachelor&rsquo;s degree preferred or comparable work experience.</li>
<li>Current CPCS or CPMSM certification or working towards certifications.</li>
<li>Experience or working knowledge of full credentialing cycles; initial payor credentialing/enrollment, maintenance and revalidation.</li>
<li>Experience or working knowledge of CredentialStream credentialing platform or other credentialing database software.</li>
<li>Excellent attention to detail, problem-solving, critical thinking, and analytical skills.</li>
<li>Strong working knowledge of word processing, spreadsheets, data entry, database experience and other computer related skills.</li></ul> 


In addition to meeting the qualifications, the ideal candidate will embody the following characteristics and possess the knowledge, skills and abilities listed below:
<ul>
<li>Holds a basic understanding of substance use disorder.</li>
<li>The highest ethical and professional standards.</li>
<li>Maintains the strictest confidentiality.</li>
<li>Excellent written and verbal communication skills.</li>
<li>Excellent attention to detail and problem-solving skills required.</li>
<li>Excellent analytical, judgment, and decision-making skills.</li>
<li>Proficient in Adobe, Excel, PowerPoint, Word, Outlook, and other Microsoft Office applications.</li>
<li>Well organized, capable of juggling multiple projects and accustomed to tight deadlines.</li>
<li>Ability to work effectively and independently with both clinical and non-clinical colleagues.</li>
<li>Ability to perform research independently.</li></ul> 


Physical Requirements and Working Conditions
The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.
<ul>
<li>Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes</li>
<li>Vision adequate to read correspondence, computer screen, forms, etc.</li>
<li>Sit for long periods of time, some bending, stooping and stretching</li>
<li>Variable workload, periodic high activity level</li>
<li>Keyboarding for long periods of time</li></ul> 


Disclaimer
The above statements are intended to describe the general nature and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of team members so classified. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed, and this job description may be updated at any time.

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.
Equal Opportunity Employer 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</div>

Payor Credentialing Specialist (remote)

Ayzel Global

Company OverviewMedBillz is a US-focused medical billing and revenue cycle management company that helps healthcare providers improve compliance, reduce claim denials, and streamline payer enrollment processes.This role is being hired and managed through Ayzel Global, supporting MedBillz&rsquo;s growing US provider base.Role OverviewWe are seeking a Medical Credentialing Specialist with hands-on experience in US provider enrollment and payer credentialing. The role requires managing end-to-end credentialing workflows, ensuring compliance with payer and regulatory requirements, and working closely with billing and operations teams to prevent revenue disruptions.This is a detail-intensive role suited for professionals who understand the administrative and compliance side of US healthcare systems.Key Responsibilities<ul><li>Manage end-to-end provider credentialing and re-credentialing processes</li><li>Enroll providers with Medicare, Medicaid, and commercial payers</li><li>Complete and maintain CAQH profiles (attestation, updates, audits)</li><li>Track credentialing timelines, expirations, and renewals</li><li>Communicate with insurance payers to resolve credentialing issues</li><li>Maintain accurate credentialing records and documentation</li><li>Coordinate with billing teams to ensure claims readiness post-credentialing</li><li>Ensure compliance with US healthcare regulations and payer requirements</li><li>Support audits and credentialing-related inquiries</li></ul>Required Qualifications<ul><li>1&ndash;3+ years of experience in US medical credentialing or provider enrollment</li><li>Hands-on experience with CAQH, Medicare, Medicaid, and commercial payers</li><li>Strong understanding of US healthcare credentialing workflows</li><li>Excellent attention to detail and documentation skills</li><li>Strong written and verbal English communication</li><li>Ability to manage multiple providers and deadlines simultaneously</li></ul>Preferred Skills (Nice to Have)<ul><li>Experience working with US medical billing or RCM companies</li><li>Familiarity with EHRs, practice management systems, or credentialing software</li><li>Experience credentialing across multiple specialties</li><li>Prior experience working with US clients or offshore healthcare teams</li></ul>What We Offer<ul><li>Full-time, stable role within a growing US healthcare services company</li><li>Competitive salary (based on experience)</li><li>Exposure to US healthcare compliance and payer systems</li><li>Structured processes and long-term growth opportunities</li><li>Supportive, systems-driven work environment</li></ul>Work Type<ul><li>Work Type: Full-time</li><li>Location: On-site / Remote (as per company policy)</li><li>Client: US Healthcare Company (MedBillz)</li></ul>Job Type: Full-timePay: Rs85,000.00 - Rs125,000.00 per monthWork Location: In person

Medical Credentialing Specialist

GRMAC Pvt ltd

Job Title: Credentialing Executive (Healthcare Process)Location: Chennai Experience: 1&ndash;5 years Industry: Health Care / Medical ServicesJob Description: Responsible for verifying and processing healthcare professionals&rsquo; credentials, licenses, and documents as per company and client standards. Ensure accuracy and timely completion of credentialing and re-credentialing activities.Key Responsibilities:<ul><li>Collect and verify doctors&rsquo;/providers&rsquo; documents and licenses</li><li>Update and maintain credentialing databases</li><li>Coordinate with healthcare providers and insurance networks</li><li>Ensure compliance with regulatory and organizational policies</li></ul>Requirements:<ul><li>Good communication skills</li><li>Attention to detail</li><li>Basic knowledge of healthcare documentation preferred</li><li>Experienced candidates can apply</li></ul>Job Types: Full-time, PermanentPay: ₹20,000.00 - ₹30,000.00 per monthBenefits:<ul><li>Health insurance</li><li>Provident Fund</li></ul>Work Location: In person

Credentialing Specialist (Healthcare Process)

Christus Health

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

Alpine Physician Partners

Job Description:Wheat Ridge Internal Medicine is an independent and entrepreneurial-minded group practice of 4 physicians and 6 advanced practice providers seeking a Internal Medicine Physician to join an established primary care clinic. The current physicians are Internal Medicine certified. We cultivate good health in all ways and strive always to deliver care of the quality and nature we expect for ourselves and our own family members.Our practice is a member of the independent practice association (IPA), PHPprime. PHPprime provides wrap-around services to help make our practice successful, including care coordination, practice transformation coaching, risk adjustment coding education, population health management, data and analytics, specialist network management, and large group contracting.The Community: Located near the western edge of Denver, Wheat Ridge is an interesting mix of old and new. Wheat Ridge is home to more than 20 parks, equestrian trails and open public space Tucked in the curve of I-70 as it heads west into the mountains, Wheat Ridge is an expansive community with a rich mix of cultural and shopping centers.Qualifications:<ul><li>MD or DO degree from fully accredited medical or osteopathic school of medicine</li><li>Successful completion of residency program (IM, FM, geriatrics, etc.)</li><li>Board Certification or Eligibility in corresponding specialty</li><li>Physician must meet employer credentialing standards</li></ul>Job Schedule: Full timeSalary: $200-220k +Benefits: <ul><li>Top-rated malpractice insurance coverage</li><li>Health/dental/vision insurance</li><li>Retirement program</li></ul>Salary Range:

Internal Medicine Physician

PCS Pakistan

About Practice Care Solutions (PCS)Practice Care Solutions (PCS) is a healthcare services company specializing in end-to-end Revenue Cycle Management (RCM) and practice support solutions for US-based healthcare providers.PCS helps physician practices, clinics, and healthcare organizations optimize revenue, reduce administrative burden, and improve operational efficiency through services such as:<ul><li>Medical billing and coding</li><li>Provider credentialing and enrollment</li><li>Accounts receivable and denial management</li><li>Eligibility and benefits verification</li><li>Compliance-driven RCM solutions</li></ul>By combining industry expertise, technology, and dedicated teams, PCS enables healthcare providers to focus on patient care while we manage their revenue operations.Job SummaryPractice Care Solutions (PCS) Pakistan is seeking a highly motivated and experienced Business Development Professional to expand our US healthcare client base. The ideal candidate will have strong hands-on experience in Revenue Cycle Management (RCM), including medical billing and provider credentialing, as well as a proven background in business development and sales for US healthcare outsourcing services.Candidates with direct business development experience selling medical billing and credentialing services to US-based healthcare providers will be strongly preferred.Key ResponsibilitiesUS Market Business Development<ul><li>Identify, target, and acquire US-based healthcare clients, including physician practices, clinics, hospitals, MSOs, and medical billing companies</li><li>Develop new business opportunities through cold calling, email campaigns, LinkedIn outreach, networking, and referrals</li><li>Conduct virtual meetings, presentations, and service demos with US healthcare decision-makers</li><li>Build and manage a strong sales pipeline focused on RCM, medical billing, and credentialing services</li></ul>Sales &amp; Client Acquisition<ul><li>Negotiate pricing, contracts, and service agreements with US healthcare providers. Sell end-to-end Revenue Cycle Management services, including:</li><li>Medical billing &amp; coding</li><li>Accounts receivable (AR) follow-ups</li><li>Provider credentialing &amp; enrollment</li><li>Eligibility &amp; benefits verification</li><li>Payment posting and denial management</li><li>Understand client pain points related to billing inefficiencies, credentialing delays, revenue leakage, and compliance</li><li>Propose customized RCM and billing solutions based on practice size, specialty, and payer mix</li></ul>Relationship &amp; Account Management<ul><li>Build and maintain long-term relationships with US clients and key stakeholders</li><li>Act as the primary point of contact during onboarding and early-stage client engagement</li><li>Coordinate with internal operations, billing, and credentialing teams to ensure smooth client transition</li><li>Ensure high levels of client satisfaction and retention</li></ul>Market Intelligence &amp; Strategy<ul><li>Stay updated on US healthcare regulations, CMS guidelines, payer policies, and credentialing requirements</li><li>Monitor industry trends related to medical billing, credentialing, and RCM outsourcing</li><li>Analyze competitors and market demand to refine business development strategies</li><li>Provide regular feedback and insights to management on market opportunities and challenges</li></ul>Education<ul><li>Bachelor&rsquo;s degree in Business, Marketing, Healthcare Administration, or a related field</li><li>MBA or relevant healthcare/RCM certifications will be a plus</li></ul>Experience<ul><li>3+ years of Business Development or Sales experience in US healthcare outsourcing</li><li>Demonstrated experience in Revenue Cycle Management, including:</li><li>Medical billing services</li><li>Provider credentialing and enrollment</li><li>Proven track record of closing US-based healthcare clients</li><li>Prior experience selling medical billing and credentialing services will be highly preferred</li></ul>Required Skills &amp; Competencies<ul><li>Strong understanding of US Revenue Cycle workflows, medical billing, coding, insurance processes, and credentialing</li><li>Excellent English communication, presentation, and negotiation skills</li><li>Experience working in US time zones</li><li>Expertise in lead generation, pipeline management, and closing deals</li><li>Proficiency in CRM tools, MS Office, and LinkedIn Sales Navigator</li><li>Ability to work independently in a performance-driven environment</li></ul>What We Offer<ul><li>Competitive salary with benefits</li><li>Growth opportunities in a fast-growing US healthcare outsourcing environment</li><li>Exposure to international clients and the US healthcare ecosystem</li><li>A professional, collaborative, and performance-driven work culture</li></ul>Job Type: Full-timePay: Rs100,000.00 - Rs120,000.00 per monthWork Location: In person

Business Development Executive

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