Credentialing Specialist

Pyramids Global, LLC; Islamabad; Presencial; PKR 1.200.000 - 1.800.000; Jornada completa

Descripción de la vacante

Pyramids Global LLC in Islamabad is seeking a Credentialing Specialist to join our Onsite team. You will manage end-to-end credentialing and provider enrollment with U.S. payers, maintain CAQH ProView records, and ensure compliance with payer requirements.

This role demands strong attention to detail, clear communication, and the ability to handle multiple credentialing cases in a fast-paced environment. On-site in Islamabad, full-time, U.S. shift support.

Formación

• Experience with U.S. credentialing and re-credentialing processes.
• Ability to verify licenses, certifications and provider data against payer requirements.
• Familiarity with CAQH ProView and credentialing workflows is preferred.

Responsabilidades

• Manage end-to-end credentialing and re-credentialing for U.S. providers.
• Collect, verify, and maintain licenses, certifications, and documentation.
• Create and update provider profiles in CAQH ProView and systems.
• Track applications, deadlines and expiring credentials; escalate when needed.
• Coordinate with payers to obtain updates and resolve requirements.
• Maintain audit-ready credentialing records and reports.
• Communicate with clients and payers by phone and email.

Conocimientos

US credentialing

CAQH ProView

Payer requirements

Documentation accuracy

Communication

Multi-case management

Attention to detail

Educación

Bachelor's degree or equivalent experience

Herramientas

CAQH ProView

Descripción del empleo

Company Description Pyramids Global LLC is a healthcare operations and revenue cycle management company that supports medical practices, behavioral health providers, clinics, and healthcare organizations across the United States. The organization helps providers improve reimbursement, reduce administrative workload, and strengthen operational efficiency through end-to-end healthcare support services. Core service areas include medical credentialing and provider enrollment, revenue cycle management, medical billing and coding, prior authorizations, denial management, and virtual medical assistant support. Pyramids Global also offers patient help desk services and eligibility and benefits verification to enhance the patient experience and maintain compliance.

Role Description The Credentialing Specialist is a full-time, on-site role based in Islamabad. This role is responsible for managing the end-to-end credentialing and provider enrollment process with payers, including initial applications, re-credentialing, and ongoing updates. The Credentialing Specialist will review and verify provider documentation, maintain accurate records in credentialing databases, and ensure compliance with healthcare regulations and payer requirements. Day-to-day tasks include coordinating with providers and internal teams, tracking application statuses, addressing payer requests, and resolving credentialing-related issues in a timely manner. The role also involves communicating with clients and payers via phone and email, supporting Medicare and other government program enrollments, and contributing to process improvements in credentialing operations.

Key Responsibilities

• Job Position: Credentialing Specialist
• Location: Onsite
• Employment Type: Full-time
• Work Schedule: 5 working days per week | U.S. shift
• Reporting Line: Credentialing Team Lead / Operations Manager

Key Responsibilities

• Manage end-to-end credentialing and re-credentialing for U.S. healthcare providers.
• Collect, verify, and maintain provider licenses, certifications, qualifications, and supporting documentation.
• Create, update, and maintain provider profiles in CAQH ProView and relevant credentialing systems.
• Track credentialing applications, re-credentialing deadlines, and expiring credentials.
• Coordinate with commercial and government payers to obtain application updates and resolve outstanding requirements.
• Follow up on pending applications, missing documents, and verification requests to facilitate timely approvals.
• Maintain accurate credentialing records, trackers, and audit-ready documentation.
• Identify discrepancies and escalation of complex cases for resolution.
• Follow company SOPs, confidentiality requirements, and applicable credentialing standards.

Skills & Competencies

• U.S. healthcare provider credentialing and re-credentialing.
• CAQH ProView and provider data management.
• Familiarity with NCQA standards and payer credentialing requirements.
• Document verification, application tracking, and deadline management.
• Strong communication, organisation, and follow-up skills.
• Attention to detail, problem-solving, and accountability.
• Ability to manage multiple cases in a fast-paced environment.

Qualifications & Experience

• Bachelor's degree preferred; equivalent relevant experience may be considered.
• Minimum 1 year of hands-on experience in U.S. healthcare credentialing or a closely related function.
• Practical familiarity with CAQH, provider documentation, and credentialing workflows.
• Exposure to commercial and government payer requirements is an advantage.
• Understanding of healthcare data confidentiality and compliance requirements.