Credentialing Specialist | US Healthcare

Revex Square is seeking an experienced Credentialing Specialist to join our team on-site in Ghauri Town, Islamabad. The ideal candidate will have strong hands-on knowledge of U.S. healthcare provider credentialing, enrollment, recredentialing, and payer follow-up. This role requires the ability to independently manage credentialing cases from initial application through approval while actively resolving enrollment delays, deficiencies, and payer-related issues. Candidates should be comfortable working with various provider types and payer systems, ensuring timely and accurate credentialing processes.

Key Responsibilities

- Manage the complete provider and group credentialing and enrollment processes.
- Complete and maintain CAQH profiles and attestations.
- Handle NPI/NPPES, PECOS, Medicare, and Medicaid enrollments.
- Submit applications to commercial and government payers.
- Manage individual, group, facility, and organization enrollments.
- Process provider additions, terminations, demographic updates, and practice-location changes.
- Oversee recredentialing and revalidation requirements.
- Complete EFT/ERA enrollment and payer portal registrations.
- Follow up aggressively with insurance companies until applications are finalized.
- Track application status, effective dates, payer IDs, contracts, and outstanding requirements.
- Review enrollment applications for accuracy before submission.
- Resolve application deficiencies, returned applications, and payer requests.
- Maintain organized credentialing trackers and provider documentation.
- Coordinate directly with providers, practices, payers, and internal Revenue Cycle Management (RCM) teams.

Required Qualifications

- Minimum of 1 year of hands-on U.S. healthcare credentialing experience preferred.
- Strong understanding of CAQH, PECOS, and NPPES systems.
- Experience with Medicare, Medicaid, and major commercial insurance payers.
- Good knowledge of individual versus group enrollment and provider affiliations.
- Strong payer follow-up and problem-solving skills.
- Ability to independently research payer requirements and resolve enrollment issues.
- Excellent written and verbal communication skills in English.
- High attention to detail and strong documentation skills.
- Ability to manage multiple providers and credentialing cases simultaneously.

Preferred Qualifications

- Experience with ABA Therapy credentialing.
- Familiarity with Texas Workers’ Compensation enrollment.
- Home Health credentialing and enrollment experience.
- Multi-state provider credentialing experience.
- Experience establishing new practices or groups with payers.
- Knowledge of payer contracting and participation agreements.
- Ability to identify enrollment issues that may impact billing or reimbursement.

We are looking for a professional who fully understands the credentialing lifecycle, not just someone who has assisted with paperwork. The successful candidate will independently communicate with payers, identify and resolve problems, follow cases through to completion, and maintain accurate credentialing records.

This is a full-time, on-site position based in Ghauri Town, Islamabad. If you have strong U.S. healthcare credentialing experience and are confident managing credentialing cases independently, we encourage you to apply.