Medical Credentialing Specialist

Billing Mate is seeking a detail-oriented Medical Credentialing Specialist to join our team and oversee the credentialing processes for healthcare providers. In this role, you will manage a team of three professionals and ensure the accurate and timely completion of credentialing, re-credentialing, and payer enrollment activities. Your expertise in provider data management, compliance with healthcare regulations, and various enrollment platforms will be essential to support our organizations provider network integrity and reimbursement capabilities. You will serve as the key liaison between providers and payers, maintaining adherence to state and federal guidelines while enhancing operational efficiency. The ideal candidate has a minimum of two years experience in US Healthcare Provider Credentialing, demonstrating proficiency in CAQH, PECOS, NPPES, Medicare, and Medicaid enrollment processes. You possess strong organizational and communication skills, documenting all credentialing activities accurately while coordinating follow-ups with payers and providers to resolve any issues promptly. This role demands the ability to work independently, manage deadlines effectively, and lead a team dedicated to maintaining the highest standard of credentialing compliance and provider network readiness.
Responsibilities

Lead and manage a team of three credentialing specialists, providing guidance, training, and performance oversight.
Coordinate and oversee provider credentialing and re-credentialing processes, ensuring timely submission and completion according to payer requirements.
Conduct thorough primary source verifications of provider credentials, including education, licensure, certifications, and work history.
Manage payer enrollment activities, including Medicare, Medicaid, and commercial insurance credentialing and re-credentialing.
Utilize credentialing platforms such as CAQH ProView and PECOS to maintain up-to-date provider data and support enrollment activities.
Maintain and update accurate records of provider licensure, certifications, and enrollment status in compliance with HIPAA and credentialing regulations.
Review and monitor state licensure and certification verifications to ensure all providers meet regulatory standards.
Serve as a point of contact for providers and payers to resolve credentialing discrepancies, application issues, or other related concerns.
Prepare and submit documentation required for payer applications and follow-up with payers to ensure process completion.
Ensure compliance with all relevant healthcare laws, payer policies, and internal credentialing procedures.
Monitor and track credentialing workflows and deadlines to meet contractual and regulatory requirements efficiently.
Implement process improvements to streamline credentialing activities and enhance data accuracy.
Collaborate with internal departments to support provider network development and maintenance.
Report regularly on credentialing team performance, progress, and compliance status to management.
Stay informed on changes in healthcare credentialing policies, regulations, and payer requirements.

Skills

Provider credentialing and recredentialing Primary Source Verification Payer Enrollment And Provider Data Management CAQH ProView PECOS And Medicare Enrollment State Licensure And Certification Verification NPPES Medicare Enrollment Medicaid Enrollment commercial insurance credentialing HIPAA And Credentialing Compliance Documentation Communication Organizational Skills Team Leadership Deadline Management

Job Details

Total Positions:

1 Post

Job Type:

Full Time/Permanent

Job Location:

Lahore, Pakistan

Gender:

Male

Minimum Experience:

2 Years

Apply Before:

Nov 16, 2026

Posting Date:

Oct 15, 2026

Billing Mate

· 101-200 employees - Lahore

At the BillingMate, we understand that the financial aspect of healthcare can be complex and time-consuming. That's why we are here to provide you with comprehensive medical billing solutions tailored to meet your specific needs. Our team of experienced professionals is dedicated to streamlining your revenue cycle management, maximizing your reimbursements, and ensuring your financial success