Credentialing Specialist

Prima Systems Pakistan is seeking a full-time Credentialing Specialist to join their team in Johar Town, Lahore. This on-site position operates during night shifts from Monday to Friday, 6:00 PM to 3:00 AM. The ideal candidate will have 1 to 2 years of experience in the healthcare industry, particularly in medical staff credentialing. The role focuses on managing the entire credentialing process for healthcare providers, ensuring accuracy and compliance while supporting smooth onboarding and revenue cycle efficiency.

Key Responsibilities:
The Credentialing Specialist will oversee the end-to-end credentialing process, which includes collecting, verifying, and maintaining accurate provider information and documentation. The role requires coordination with medical staff, insurance companies, and regulatory bodies to facilitate timely credentialing, re-credentialing, and enrollment, especially with Medicare and other payers. Daily tasks involve reviewing credentialing applications, tracking their status, resolving discrepancies, and responding to inquiries from providers and clients. Maintaining compliance with company policies and relevant healthcare standards is essential. The specialist will also collaborate closely with internal teams to ensure records are up to date and support overall operational efficiency.

Required Qualifications:
- A graduation degree in any field is required, with a preference for healthcare administration, business, or related disciplines.
- At least one year of experience in medical staff credentialing, including managing provider enrollment and verification processes.
- Familiarity with credentialing platforms such as CAQH, PECOS, NPI, and various insurance portals.
- Strong communication skills, both written and verbal, to effectively interact with providers, payers, and internal teams.
- Proven customer service skills emphasizing responsiveness, professionalism, and relationship management.
- Working knowledge of Medicare requirements and payer-specific credentialing regulations.
- Attention to detail, excellent organizational and time management abilities.
- Proficiency with credentialing or practice management software.

Preferred Qualifications and Benefits:
- Experience with healthcare BPO operations is considered an advantage.

This role offers an opportunity to work in a dynamic healthcare environment, contributing directly to the credentialing process that supports provider participation and reimbursement. The night shift schedule may appeal to candidates seeking non-traditional working hours within a structured, professional setting.