Credentialing Specialist

Location: Bahria Town Phase 7, Rawalpindi (Preference given to residents of Bahria, DHA, or nearby areas)

Sequel Technologies is a software company specializing in healthcare IT and medical billing services for the US market. We are currently looking for a detail-oriented and experienced Credentialing Specialist to oversee the provider credentialing and enrollment processes with Medicare, Medicaid, and commercial insurance payers. The ideal candidate will handle the preparation and submission of enrollment applications, maintain accurate provider information, track application statuses, manage recredentialing and revalidation, and coordinate with payers to ensure providers are properly enrolled and active for billing purposes.

Key Responsibilities
- Manage credentialing and enrollment processes for providers with Medicare, Medicaid, and commercial insurance plans.
- Review provider documents to ensure accuracy, completeness, and compliance with payer requirements.
- Create and maintain provider profiles in CAQH, PECOS, NPPES, and various payer portals.
- Submit initial credentialing, recredentialing, and enrollment applications in a timely manner.
- Follow up with insurance companies regarding application status and any pending requests.
- Track provider licenses, certifications, malpractice insurance, and other necessary credentials.
- Identify and resolve issues or missing information that could delay enrollment.
- Maintain accurate records of provider and group enrollment information.
- Verify provider network participation, effective dates, and payer affiliations.
- Communicate effectively with providers, practice managers, and insurance representatives about credentialing requirements.
- Prepare professional status updates, follow-up emails, and credentialing reports.
- Ensure all applications are completed and submitted within required deadlines and according to payer guidelines.
- Coordinate with the EDI team to confirm providers are properly enrolled before claims submission.
- Assist with ERA/EFT enrollment as part of the payer enrollment process when required.
- Maintain confidentiality of provider and client information in compliance with HIPAA and company policies.

Required Qualifications
- Bachelor’s degree from a reputable university.
- Minimum of 2 years’ experience in credentialing or a related field.
- Knowledge or experience in provider credentialing and payer enrollment processes.
- Strong attention to detail and excellent organizational skills.
- Effective communication and follow-up abilities.

Preferred Qualifications and Benefits
- Familiarity with EHR/EMR systems is preferred.

Work Schedule
- Summer hours: 5:00 PM to 2:00 AM
- Winter hours: 6:00 PM to 3:00 AM

Benefits
- Healthcare coverage including OPD and IPD
- Entertainment allowance
- Cellular allowance
- Provident fund

This position offers an opportunity to work in a dynamic healthcare IT environment, supporting critical provider enrollment functions that directly impact billing and revenue cycle management. Candidates residing near Bahria Town, DHA, or surrounding areas are preferred to facilitate timely coordination and communication.