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 process with Medicare, Medicaid, and commercial insurance payers. The ideal candidate will handle the preparation and submission of enrollment applications, maintain 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 to monitor application status and address any pending requests.
- Track and verify provider licenses, certifications, malpractice insurance, and other necessary credentials.
- Identify and resolve issues or missing information that could delay enrollment processes.
- Maintain accurate and up-to-date records of provider and group enrollment information.
- Verify provider network participation, effective dates, and payer affiliations to ensure billing eligibility.
- Communicate effectively with providers, practice managers, and insurance representatives regarding credentialing requirements and updates.
- Prepare professional status updates, follow-up emails, and credentialing reports as needed.
- Ensure all applications are completed and submitted within required deadlines and according to payer guidelines.
- Coordinate with the Electronic Data Interchange (EDI) team to confirm providers are enrolled before claims submission.
- Assist with Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) enrollment when required as part of the payer enrollment process.
- Maintain strict 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.
- Solid understanding of provider credentialing and payer enrollment processes.
- Strong attention to detail and excellent organizational skills.
- Effective communication and follow-up abilities to manage multiple stakeholders.

Preferred Qualifications and Benefits

- Familiarity with Electronic Health Record (EHR) or Electronic Medical Record (EMR) systems is preferred.
- Work schedule includes evening shifts: 5:00 PM to 2:00 AM during summer and 6:00 PM to 3:00 AM in winter.

Benefits

- Comprehensive healthcare coverage including outpatient (OPD) and inpatient (IPD) services.
- Entertainment allowance to support work-life balance.
- Cellular allowance to assist with communication needs.
- Provident fund for long-term financial security.

This role offers an excellent opportunity for professionals seeking to advance their career in healthcare credentialing within a dynamic and supportive environment. Candidates residing near Bahria Town, DHA, or adjacent areas are preferred to facilitate timely coordination and communication.