Credentialing Specialist
20 hours ago
2 days ago Be among the first 25 applicants
Department: Medical Staff Services / Provider Relations
We are seeking a highly skilled and detail-oriented Credentialing Specialist with 5+ years of experience to join our team. The ideal candidate will be responsible for managing the full-cycle credentialing and re-credentialing process for healthcare providers, ensuring compliance with regulatory standards and payer requirements. This role demands a deep understanding of credentialing policies, provider enrollment, and healthcare regulations such as NCQA, URAC, and CMS guidelines.
Location: New Garden Town, Lahore
Job Type: Full-Time
Department: Medical Staff Services / Provider Relations
We are seeking a highly skilled and detail-oriented Credentialing Specialist with 5+ years of experience to join our team. The ideal candidate will be responsible for managing the full-cycle credentialing and re-credentialing process for healthcare providers, ensuring compliance with regulatory standards and payer requirements. This role demands a deep understanding of credentialing policies, provider enrollment, and healthcare regulations such as NCQA, URAC, and CMS guidelines.
Key Responsibilities:- Coordinate and manage all aspects of initial credentialing and recredentialing for healthcare providers.
- Collect, verify, and review provider credentials, including education, licensure, certifications, work history, malpractice history, and DEA registrations.
- Submit and track provider applications for insurance panels and payers (Medicare, Medicaid, commercial insurance).
- Maintain and update provider information in credentialing databases and ensure records are current and accurate.
- Ensure compliance with organizational policies, payer requirements, and federal/state regulations (e.g., NCQA, URAC, JCAHO).
- Liaise with providers, insurance companies, medical staff offices, and regulatory agencies as needed.
- Prepare credentialing files for review and approval by committees or credentialing boards.
- Respond promptly to audits and information requests related to credentialing.
- Stay updated on changes in healthcare regulations and payer requirements.
- Minimum 5 years of experience in provider credentialing and enrollment in a healthcare or medical office environment.
- In-depth knowledge of credentialing processes, CAQH, PECOS, NPPES, and payer enrollment systems.
- Familiarity with industry standards (NCQA, CMS, URAC, etc.).
- Experience with credentialing software (e.g., Modio, IntelliCred, MedTrainer, Symplr) is highly preferred.
- Strong attention to detail, organizational skills, and ability to manage multiple priorities.
- Excellent communication and interpersonal skills.
- Ability to work independently and collaboratively in a fast-paced environment.
- Competitive salary based on experience
- Paid time off and holidays
- Professional development opportunities
- Salary budget (70k-100k PKR)
- Seniority levelMid-Senior level
- Employment typeFull-time
- Job functionHealth Care Provider
- IndustriesHospitals and Health Care
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