Credentialing Specialist

4 weeks ago

Lahore, Punjab, Pakistan MedICD Full time

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.
Qualifications:
  • 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.
Benefits:
  • Competitive salary based on experience
  • Paid time off and holidays
  • Professional development opportunities
  • Salary budget (70k-100k PKR)
Seniority level
  • Seniority levelMid-Senior level
Employment type
  • Employment typeFull-time
Job function
  • Job functionHealth Care Provider
  • IndustriesHospitals and Health Care

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