Medical Credentialing Specialist

Job Summary:

As a Medical Insurance Credentialing Specialist, you will be responsible for overseeing all aspects of credentialing processes within our organization. The successful candidate will be responsible for ensuring that our network of healthcare providers meets all regulatory and compliance requirements, as well as maintaining relationships with insurance carriers and managing the credentialing team.

Job Location: Rawalpindi, Pakistan

Duties and Responsibilities:

• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications
• Update each provider’s CAQH database file timely according to the schedule published by CMS
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
• Complete revalidation requests issued by government payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers
• Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
• Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases Other duties as assigned
• Can help setup insurance portals as required
• Can help with EDI/ERA/EFT setups
• Maintain internal provider grid to ensure all information is accurate and logins are available

Requirements:

• Bachelor's degree in healthcare administration, business administration, or related field
• Minimum of 2 year of experience in healthcare credentialing.
• In-depth knowledge of credentialing processes, regulations, and accreditation standards
• Strong analytical and problem-solving skills with attention to detail
• Excellent communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders
• Proficiency in Microsoft Office Suite and credentialing software
• Certification in Healthcare Credentialing (e.g., CPCS, CPMSM) preferred
• The incumbent should be flexible to work in night shift

Perks & Benefits:

• Market competitive salary with performance bonuses
• Growth Opportunities 
• Paid Annual & Sick Leaves
• Provident fund and EOBI 

About the Company:

As a leading healthcare revenue cycle management company, Wise Medical Billing (WMB) provides an array of integrated, technology-driven solutions for healthcare organizations, medical practices, Hospitals, Labs, Nursing Homes and other healthcare providers across the USA. A healthcare organization needs a partner like WMB who can help enhance clinical workflows, increase revenue, improve patient care, and reduce operational costs in today's challenging healthcare environment. WMB is widely praised for its diverse and supportive culture, which attracts highly qualified professionals who are committed to improving the quality of healthcare.