Medical Credentialing Specialist

4 weeks ago

Karachi, Sindh, Pakistan Bridge Healthcare Management Full time

We are looking for an experienced Medical Credentialing Specialist to join our team. The ideal candidate must have comprehensive knowledge of the end-to-end credentialing process for US healthcare providers. This role requires exceptional attention to detail, strong organizational skills, and the ability to manage multiple credentialing applications efficiently.

Key Responsibilities:
  1. Provider Enrollment & Credentialing: Handle credentialing and re-credentialing of physicians, nurses, and other healthcare providers with insurance networks, Medicare, Medicaid, and other payers.
  2. Documentation & Verification: Collect, review, and submit provider documentation, ensuring all information is accurate and up-to-date.
  3. Payer Applications & Contracts: Complete, track, and follow up on payer applications, contracts, and agreements to ensure timely approvals.
  4. CAQH & NPI Management: Maintain and update provider profiles on CAQH, NPPES (NPI registration), and other credentialing databases.
  5. Follow-Ups & Compliance: Communicate with insurance companies and credentialing organizations to track application progress, resolve issues, and ensure compliance with industry regulations.
  6. License & Certification Renewals: Monitor and ensure timely renewal of provider licenses, certifications, and other necessary credentials.
  7. Database & Record-Keeping: Maintain accurate and organized records of all credentialing activities.
  8. Communication & Coordination: Work closely with healthcare providers, insurance companies, and internal teams to streamline the credentialing process.
Requirements:
  1. Proven experience in medical credentialing for US healthcare providers.
  2. Strong knowledge of insurance payer enrollment, Medicare/Medicaid credentialing, and CAQH management.
  3. Experience handling commercial and government payers (BCBS, Aetna, Cigna, UHC, etc.).
  4. Ability to independently manage the entire credentialing process from start to finish.
  5. Strong understanding of HIPAA compliance and medical credentialing guidelines.
  6. Excellent communication and follow-up skills for dealing with insurance representatives.
  7. Proficiency in credentialing software and database management tools.
  8. Detail-oriented with strong organizational and time-management skills.
Why Join Us?
  • Opportunity to work with a growing Medical Billing company handling US-based clients.
  • Professional work environment with growth potential.
  • Competitive compensation based on experience and expertise.
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