Description:
Billing Nest (Private) Limited is seeking a detail-oriented and experienced Credentialing Executive to join our growing team. In this role, you will be responsible for managing the end-to-end provider enrollment process, ensuring healthcare providers are properly credentialed and compliant with network standards. This position is ideal for a proactive professional with a strong background in U.S. healthcare credentialing who excels at managing complex applications and resolving processing hurdles efficiently.
Key Responsibilities
- Execute and manage the enrollment process for Medicare, Medicaid, and commercial payers.
- Navigate, update, and maintain accurate provider data across CAQH, NPI/NPPES, PECOS, and various specific payer portals.
- Process and oversee both individual and group provider enrollments from start to finish.
- Actively track all credentialing applications to ensure timely processing and network participation.
- Conduct consistent payer follow-ups and take ownership of issue resolution throughout the credentialing lifecycle.
- Maintain strict compliance with U.S. healthcare credentialing guidelines, ensuring all provider documentation is current and securely stored.
Requirements
- Experience: Minimum of 1+ year of dedicated experience in U.S. healthcare credentialing.
- Location Constraints: Applicants must currently reside in Rawalpindi or Islamabad.
- Technical Knowledge: Proven expertise working with Medicare, Medicaid, commercial payer enrollments, and utilizing systems like CAQH, PECOS, and NPI/NPPES.
- Core Competencies: Strong organizational skills for meticulous application tracking, persistence in payer follow-ups, and a solution-oriented approach to individual and group issue resolution.