Credentialing Executive

The Credentialing Executive is responsible for managing the provider enrollment and credentialing process with insurance companies, hospitals, and other healthcare organizations. This role ensures all providers are properly credentialed and enrolled to receive timely reimbursement for medical services, maintaining compliance with payer and regulatory requirements.

Key Responsibilities:

· Prepare, review, and submit credentialing and re-credentialing applications for healthcare providers with commercial and government insurance payers (e.g., Medicare, Medicaid, BCBS, Aetna, UnitedHealthcare, Cigna, etc.).

· Maintain up-to-date records of providers in credentialing databases and online systems.

· Track the status of credentialing and enrollment applications, follow up with payers, and resolve any discrepancies or issues.

· Verify provider credentials, including licenses, board certifications, DEA, malpractice insurance, and other necessary documents.

· Coordinate with internal billing teams to ensure providers are properly linked and active with payers before billing.

· Update and maintain CAQH profiles, NPI registrations, and PECOS enrollments.

· Manage expirables (licenses, insurance, certifications) and notify providers of renewals.

· Ensure compliance with federal, state, and payer-specific regulations.

· Generate and maintain credentialing reports and dashboards.

· Communicate professionally with providers, practice managers, and insurance representatives.

Required Qualifications:

· Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent work experience).

· 1–3 years of experience in medical credentialing, provider enrollment, or medical billing.

· Knowledge of CAQH, NPPES, PECOS, and payer portals.

· Strong understanding of commercial and government payer processes.

· Excellent communication and organizational skills.

· Proficiency in MS Office (Excel, Word, Outlook) and credentialing software.

· Ability to handle multiple tasks, prioritize, and meet deadlines.

Preferred Qualifications:

· Experience with US-based healthcare systems or RCM/BPO companies.

· Certification in credentialing (e.g., CPCS, CPMSM) is a plus.

· Knowledge of medical billing and compliance regulations (HIPAA, CMS).

Key Competencies:

· Attention to detail and accuracy

· Strong problem-solving and analytical skills

· Professional communication and interpersonal skills

· Time management and ability to work independently

· Team collaboration

Job Type: Full-time

Pay: Rs30, Rs50,000.00 per month

Application Question(s):

• Will you be able to work in night shift(6pm to 3am)?
• Will you be able to commute to Bahria Town Phase 7 Rawalpindi?

Work Location: In person