Credentialing Specialist

Description:

This is a full-time, on-site Credentialing Specialist role based in Rawalpindi. The Credentialing Specialist will manage provider enrollment and credentialing with insurance payers and healthcare networks, including preparing, submitting, and tracking applications. Duties include maintaining accurate provider records, monitoring credentialing and re-credentialing timelines, and ensuring compliance with payer and regulatory requirements. The role involves regular communication with providers, payers, and internal teams to resolve credentialing issues, verify documentation, and support timely claim submission. The Credentialing Specialist will also assist in updating internal systems, generating status reports, and supporting continuous improvement of credentialing processes.

Qualifications

• Strong understanding of healthcare credentialing, provider enrollment, and payer requirements, with experience in revenue cycle or medical billing environments.
• Proficiency in data entry, document management, and use of practice management or credentialing software, with attention to accuracy and detail.
• Effective communication and interpersonal skills for collaborating with providers, payers, and internal teams, including clear written and verbal English.
• Ability to manage multiple applications and deadlines, prioritize tasks, and follow structured workflows with minimal supervision.
• Knowledge of U.S. healthcare insurance basics, including commercial payers, Medicare/Medicaid, and network participation processes, is highly beneficial.
• Prior experience in credentialing, provider onboarding, or related administrative roles in healthcare is preferred.
• Bachelor’s degree in business, healthcare administration, or a related field is advantageous; equivalent relevant experience will be considered.
• Commitment to confidentiality, compliance, and quality standards, with a willingness to learn and adapt to evolving payer and regulatory requirements.