Credentialing Specialist

Pyramids Global LLC, a leading healthcare operations and revenue cycle management company, is seeking a full-time Credentialing Specialist to join their onsite team in Islamabad. This role involves managing the complete credentialing and provider enrollment process for U.S. healthcare providers, including initial applications, re-credentialing, and ongoing updates. The specialist will work closely with providers, payers, and internal teams to ensure accurate documentation, compliance with healthcare regulations, and timely processing of credentialing requests. The position operates on a U.S. shift schedule, reporting to the Credentialing Team Lead or Operations Manager.

Key Responsibilities

- Manage end-to-end credentialing and re-credentialing processes for U.S. healthcare providers.
- Collect, verify, and maintain provider licenses, certifications, qualifications, and other supporting documentation.
- Create, update, and maintain provider profiles in CAQH ProView and other relevant credentialing systems.
- Track credentialing applications, monitor re-credentialing deadlines, and manage expiring credentials.
- Coordinate with commercial and government payers to obtain application updates and resolve outstanding requirements.
- Follow up on pending applications, missing documents, and verification requests to ensure timely approvals.
- Maintain accurate credentialing records, trackers, and audit-ready documentation.
- Identify discrepancies and escalate complex cases for resolution.
- Adhere to company standard operating procedures (SOPs), confidentiality policies, and applicable credentialing standards.

Required Qualifications

- Minimum of one year of hands-on experience in U.S. healthcare credentialing or a closely related function.
- Practical knowledge of CAQH ProView and provider data management.
- Familiarity with document verification, application tracking, and deadline management.
- Strong communication, organizational, and follow-up skills.
- Attention to detail, problem-solving abilities, and accountability.
- Ability to manage multiple cases efficiently in a fast-paced environment.
- Understanding of healthcare data confidentiality and compliance requirements.

Preferred Qualifications

- Bachelor’s degree is preferred; however, equivalent relevant experience will be considered.
- Exposure to commercial and government payer credentialing requirements, including Medicare and other government programs.
- Familiarity with NCQA standards and payer credentialing guidelines.

Pyramids Global LLC supports medical practices, behavioral health providers, clinics, and healthcare organizations across the United States by enhancing reimbursement, reducing administrative workload, and improving operational efficiency. The company’s services include medical credentialing and provider enrollment, revenue cycle management, medical billing and coding, prior authorizations, denial management, virtual medical assistant support, patient help desk services, and eligibility and benefits verification.

This role offers the opportunity to contribute to process improvements within credentialing operations while working in a dynamic healthcare environment. The Credentialing Specialist will play a vital role in maintaining compliance and supporting the smooth functioning of healthcare provider networks.

Candidates interested in this position are encouraged to apply through the company’s official recruitment channels.