Credentialing Specialist | US Healthcare

Revex Square is seeking an experienced Credentialing Specialist to join our team on-site in Ghauri Town, Islamabad. The ideal candidate will have strong hands-on knowledge of U.S. healthcare provider credentialing, enrollment, recredentialing, and payer follow-up. This role requires managing credentialing cases independently from initial application through approval, proactively resolving enrollment delays, deficiencies, and payer-related issues. The position demands a professional who understands the full credentialing lifecycle and can maintain accurate records while effectively communicating with payers and internal teams.

Key Responsibilities
- Manage complete provider and group credentialing and enrollment processes.
- Complete and maintain CAQH profiles and attestations.
- Handle NPI/NPPES, PECOS, Medicare, and Medicaid enrollments.
- Submit applications to commercial and government payers.
- Manage enrollments for individuals, groups, facilities, and organizations.
- Process provider additions, terminations, demographic updates, and practice-location changes.
- Oversee recredentialing and revalidation requirements.
- Complete EFT/ERA enrollment and payer portal registrations.
- Follow up persistently with insurance companies until applications are finalized.
- Track application status, effective dates, payer IDs, contracts, and outstanding requirements.
- Review enrollment applications for accuracy before submission.
- Resolve application deficiencies, returned applications, and payer requests.
- Maintain organized credentialing trackers and provider documentation.
- Coordinate directly with providers, practices, payers, and internal Revenue Cycle Management (RCM) teams.

Required Qualifications
- Minimum of 1 year of hands-on U.S. healthcare credentialing experience preferred.
- Strong understanding of CAQH, PECOS, and NPPES systems.
- Experience with Medicare, Medicaid, and major commercial insurance payers.
- Good knowledge of individual versus group enrollment and provider affiliations.
- Strong payer follow-up and problem-solving skills.
- Ability to independently research payer requirements and resolve enrollment issues.
- Excellent written and verbal communication skills in English.
- High attention to detail and strong documentation skills.
- Capability to manage multiple providers and credentialing cases simultaneously.

Preferred Qualifications
- Experience with ABA Therapy credentialing.
- Knowledge of Texas Workers’ Compensation enrollment processes.
- Background in Home Health credentialing and enrollment.
- Multi-state provider credentialing experience.
- Experience establishing new practices or groups with payers.
- Familiarity with payer contracting and participation agreements.
- Ability to identify enrollment issues that may impact billing or reimbursement.

We are looking for a professional who goes beyond assisting with paperwork and understands the entire credentialing lifecycle. The candidate must be able to independently communicate with payers, identify and resolve problems, follow cases through to completion, and maintain accurate credentialing records.

This is a full-time, on-site position based in Ghauri Town, Islamabad. If you have strong U.S. healthcare credentialing experience and are confident in managing credentialing cases independently, we encourage you to apply.