Credentialing Executive (US Health Market)

Physicians Revenue Group, Inc.

Lahore , Pakistan

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TEKBOOX is seeking a detail-oriented and experienced Credentialing Executive with 2 to 3 years of expertise in US healthcare credentialing. The successful candidate will be responsible for managing the entire credentialing lifecycle, including enrollment, re-credentialing, and maintaining accurate documentation. This role ensures that healthcare providers comply with the requirements set by insurance companies, healthcare networks, and regulatory bodies.

Key Responsibilities

- Manage the end-to-end credentialing and re-credentialing processes for healthcare providers.
- Prepare, verify, and maintain all necessary credentialing documents such as licenses, certifications, malpractice insurance, and educational credentials.
- Handle provider enrollment with Medicare, Medicaid, commercial insurance payers, and other healthcare networks.
- Complete and maintain CAQH profiles, ensuring provider information is accurate and current.
- Track credentialing applications, follow up with insurance companies, and ensure timely processing.
- Verify provider licenses, qualifications, work history, and other required credentials.
- Monitor expiration dates of credentials and coordinate timely renewals.
- Maintain accurate credentialing records, databases, and status reports.
- Collaborate with healthcare providers, insurance companies, and internal billing or operations teams to resolve credentialing issues.
- Ensure compliance with payer requirements, organizational policies, and US healthcare regulations.
- Identify and resolve discrepancies in applications, missing documentation, and enrollment delays.

Required Qualifications

- Bachelor’s degree in Business Administration, Healthcare Administration, or a related field is preferred.
- 2 to 3 years of hands-on experience in US healthcare credentialing.
- Practical knowledge of Medicare, Medicaid, commercial payer enrollment, and CAQH.
- Familiarity with NPI registration, PECOS, and provider enrollment procedures.
- Strong understanding of US healthcare processes and insurance payer requirements.
- Excellent English communication skills, with strong attention to documentation and follow-up.

Job Location and Work Schedule

This position is based onsite at DHA Phase 3, Y Block, Lahore. The working hours are during the night shift, from 7:00 PM to 4:00 AM, five days a week.

Interested candidates who meet the above qualifications are encouraged to apply. This is an excellent opportunity for professionals looking to advance their career in healthcare credentialing within a dynamic organization.