provider credentialing specialist

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

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

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

Jawa Health Care

Job Summary:The Credentialing Executive is responsible for managing the end-to-end provider credentialing and re-credentialing process with insurance payers, ensuring compliance with regulatory standards and maintaining accurate provider records.Key Responsibilities:<ul><li>Handle provider enrollment and credentialing with Medicare, Medicaid, and commercial insurance payers</li><li>Prepare and submit credentialing applications (initial, revalidation, and re-credentialing)</li><li>Maintain and update CAQH profiles and ensure data accuracy</li><li>Track application status and follow up with payers for approvals</li><li>Maintain a database of provider credentials including licenses, certifications, and malpractice insurance</li><li>Ensure compliance with NCQA, CMS, and payer guidelines</li><li>Coordinate with internal departments (billing, compliance, operations)</li><li>Manage re-credentialing timelines and ensure timely renewals</li><li>Resolve credentialing-related issues and denials</li><li>Maintain proper documentation and audit-ready files</li></ul>Required Qualifications:<ul><li>Bachelor&rsquo;s degree (Healthcare Administration preferred)</li><li>1&ndash;3 years of experience in medical credentialing/enrollment (DME experience preferred)</li><li>Strong knowledge of Medicare, Medicaid, and commercial payer processes</li><li>Experience with CAQH, PECOS, NPPES systems</li><li>Good communication and follow-up skills</li></ul>Skills Required:<ul><li>Attention to detail</li><li>Strong organizational skills</li><li>Time management and deadline handling</li><li>Knowledge of healthcare compliance regulations</li><li>Proficiency in MS Office / Excel</li></ul>Preferred Qualifications:<ul><li>Experience in DME (Durable Medical Equipment) credentialing</li><li>Familiarity with US healthcare system</li><li>Prior experience working in night shift (for US-based processes)</li></ul>KPIs / Performance Metrics:<ul><li>Application turnaround time</li><li>Approval rate from payers</li><li>Accuracy of submitted applications</li><li>Re-credentialing completion rate</li><li>Compliance audit results</li></ul>Work Timings (Optional &ndash; Customize):<ul><li>Night Shift (US Time Zone)</li><li>Example: 6:00 PM &ndash; 3:00 AM (PKT)</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Credentialing Executive Medical Billing

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

HealthDrive

<div>Overview:
<div>
The Corporate Recruiter and Onboarding Specialist will facilitate the in-house Corporate Recruitment, support the Provider Recruitment team with new hires and facilitate the onboarding, as well as orientation process for new hires, both Corporate staff and Providers. This position is integral in creating an exceptional experience for every candidate. The person in this role will work in partnership with a variety of corporate department stakeholders, recruitment team members, the Executive Management Team, Hiring Managers, and other subject matter experts to recruit, onboard, credential, foster relationships, provide administrative support and orientation facilitation. The Corporate Recruiter and Onboarding Specialist will develop a thorough understanding of the recruiting, onboarding and orientation best practices to support the company&rsquo;s full cycle recruitment process.</div><div></div><div> 
The hourly pay range for this position is $25.00 - $28.00 per hour, depending on related experience.</div><div></div><div> 
What's in it for you: PPO Medical, Dental, and Vision Insurance, 401(k) + Company match, Paid Time Off, remote schedule opportunity, Verizon Wireless, Dell, and other employee discounts, profit sharing, and employee referral bonuses.</div><div></div><div> 
HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing, and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence.</div>
Responsibilities:
<ul><li>Source, screen, and present candidates to corporate hiring managers for their open requisitions.<ul><li>
Post jobs in company platforms</li><li>
Outbound recruitment and sourcing activities as necessary</li></ul></li><li>
Manage corporate and provider new hire onboarding process including the following:</li><li>
Manage receipt of all required documentation</li><li>
Ensure all required documents are received in-house prior to start date</li><li>
Communicate with appropriate teammates on potential delays in start date due to documentation/credentialing issues</li><li>
Troubleshoot potential issues with license and credentialing</li><li>
Coordinate all Orientation training schedules and Shadow Days</li><li>
Confirming days/times for Orientation sessions</li><li>
Sending all Outlook meeting invitations</li><li>
Hosting all Orientations</li><li>
Update candidate records in our applicant tracking system as well as the HealthDrive Credentialing App. with credentials and onboarding materials as appropriate</li><li>
Serve as a resource and contact for corporate and provider candidates throughout the Onboarding process</li><li>
In conjunction with Accounts Payable &amp; VP of Provider Recruitment and Onboarding, reconcile the Onboarding process expenses on a monthly basis</li><li>
Ongoing collaboration with Health Drive SMEs on potential process improvements</li><li>
Work with recruitment leadership and Human Resources to design and implement Onboarding and Orientation processes that are sustainable, scalable, and support the needs of the business</li></ul> 
<div></div>
Qualifications:

This individual must possess confidence, experience, and skills to support organizational activities. They must have the ability to manage conflict, be a good communicator, active listener, and possess strong decision-making skills.<ul><li>
Detail-oriented with effective time management, organizational, and problem-solving skills</li><li>
Experience in optimizing processes and increasing efficiencies</li><li>
Ability to troubleshoot scheduling issues as they arise</li><li>
Excellent written/oral communication skills with the ability to interact effectively with team members and candidates at all levels with professionalism, tact, and diplomacy</li></ul><div>
To qualify for this role, the individual must have a minimum of a Bachelor&rsquo;s Degree in Business Administration or a related field and/or a minimum of 2 years of equivalent work experience.</div></div>

Corporate Recruiter and Onboarding Specialist

Job Title: Credentialing Expert Department: Credentialing / RCM Industry: Healthcare / DME Experience: 1&ndash;3 years (Fresh + Experienced can apply)Job SummaryWe are looking for a detail-oriented Credentialing Expert to manage provider enrollment, re-credentialing, and compliance with insurance networks. The ideal candidate will ensure timely onboarding of providers and maintain accurate credentialing records.Key Responsibilities<ul><li>Handle provider enrollment with Medicare, Medicaid, and commercial payers</li><li>Manage CAQH profiles (creation, updating, attestation)</li><li>Submit and track credentialing and re-credentialing applications</li><li>Follow up with insurance companies for application status</li><li>Maintain provider documentation (licenses, NPI, DEA, malpractice insurance)</li><li>Ensure compliance with payer requirements and deadlines</li><li>Resolve credentialing-related issues and delays</li><li>Maintain accurate records in credentialing systems</li></ul>Requirements<ul><li>Bachelor&rsquo;s degree (preferred)</li><li>Knowledge of US healthcare credentialing process</li><li>Familiarity with CAQH, PECOS, NPPES</li><li>Strong communication and follow-up skills</li><li>Good command of MS Excel and documentation</li></ul><ul><li>Shift: Night shift (US timing)</li><li>6pm to 3am</li><li>Monday to Friday</li><li>Saturday Sunday off</li><li>Location: On-site</li><li>Salary: Market competitive</li><li>Perks: Growth, training,</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Credentialing Expert

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