Medical Credentialing & Payer Contracting Specialist

We are partnering with a growing U.S.-based healthcare organization specializing in Oral Appliance Therapy (OAT) for Obstructive Sleep Apnea. The company seeks a Karachi-based specialist to manage the full commercial payer contracting process. This role also includes Medicare DMEPOS enrollment and revenue cycle management. Initially, this opportunity may begin as a one-time contracting project but has the potential to evolve into a long-term position based on performance and fit.

Key Responsibilities

Commercial Payer Credentialing & Contracting:
- Identify appropriate commercial payer networks and initiate participation requests.
- Prepare and submit DME/HME credentialing applications, including licensing, accreditation, and organizational documentation.
- Follow up with payer credentialing and contracting teams, responding promptly to information requests.
- Review proposed contracts, fee schedules, and reimbursement terms; engage in negotiations as needed.
- Secure fully executed in-network agreements and confirm their effective dates.
- Verify that the provider is correctly loaded in payer systems before claims submission.
- Maintain accurate contract and credentialing records, tracking recredentialing deadlines.

Medicare / DMEPOS:
- Manage Medicare DMEPOS enrollment through PECOS.
- Handle PTAN enrollment and ongoing maintenance.
- Ensure compliance with supplier standards, accreditation, and licensing documentation.
- Oversee revalidations and enrollment updates.

Medical Billing & Revenue Cycle Management (RCM):
- Conduct eligibility and benefits verification.
- Manage prior authorizations and review medical necessity documentation.
- Perform HCPCS coding and submit electronic or paper claims.
- Post payments, follow up on accounts receivable, and identify underpayments.
- Handle denial management, including corrections, reconsiderations, and appeals.
- Generate revenue cycle reports to support financial oversight.

Required Qualifications
- Demonstrated, hands-on experience managing commercial payer contracting for DME/HME suppliers from initial application through to executed contracts and in-network status.
- Strong understanding of U.S. healthcare credentialing and payer processes.
- Experience with Medicare DMEPOS enrollment, PECOS, and PTAN management.
- Proficiency in medical billing and revenue cycle management.
- Excellent written and verbal English communication skills for direct interaction with U.S. payers.
- Residency in Karachi, Pakistan.

Preferred Qualifications
- Experience in oral appliance therapy, sleep medicine, or dental sleep medicine.
- Familiarity with HCPCS code E0486.
- Proven track record of contracting with multiple DME/HME organizations.

This role offers the chance to contribute to a specialized healthcare provider’s growth and operational success, with potential for ongoing engagement based on results.