Credentialing Specialist

Sequel Technologies

Saddar

On-site

PKR 600,000 - 900,000

Full time

4 days ago

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Benefits offered by this job

Healthcare (OPD + IPD)

Entertainment Allowance

Cellular Allowance

Provident Fund

Job summary

Sequel Technologies in Rawalpindi is seeking a Credentialing Specialist to manage provider credentialing and enrollment with Medicare, Medicaid, and commercial payers. You will prepare and submit enrollment applications, maintain provider information, and track status.

You will coordinate with payers, maintain CAQH/PECOS/NPPES profiles, review documents for accuracy, and ensure active enrollment before claims are submitted.

Qualifications

2-3 years of credentialing experience required.
Bachelor's degree from a reputable university.
Familiarity with EHR/EMR systems preferred.

Responsibilities

Manage credentialing and enrollment with Medicare, Medicaid, and commercial plans.
Review provider documents for accuracy and compliance.
Create and maintain provider profiles in CAQH, PECOS, NPPES, and payer portals.
Submit initial credentialing, recredentialing, and enrollment applications.
Follow up with payers on application status and requests.
Track licenses, certifications, malpractice insurance, and other credentials.
Identify and resolve issues or missing information that may delay enrollment.
Maintain confidentiality of provider and client information per HIPAA and company policies.

Skills

Credentialing experience

Attention to detail

Communication

Education

Bachelor's degree

Tools

EHR/EMR systems

Job description

Location: Bahria Town Phase 7, Rawalpindi (Preference for residents of Bahria, DHA, or nearby areas)

Company Description

Sequel Technologies, a software company providing healthcare IT and medical billing services to the US market.

Job Summary

We are seeking a detail-oriented and experienced Credentialing Specialist to manage the provider credentialing and enrollment process with Medicare, Medicaid, and commercial insurance payers. The specialist will be responsible for preparing and submitting enrollment applications, maintaining provider information, tracking application status, handling recredentialing and revalidation, and coordinating with payers to ensure providers are properly enrolled and active for billing.

Responsibilities

Manage providers for credentialing and enrollment with Medicare, Medicaid, and commercial insurance plans.
Review provider documents for accuracy, completeness, and compliance.
Create and maintain provider profiles in CAQH, PECOS, NPPES, and payer portals.
Submit initial credentialing, recredentialing, and enrollment applications.
Follow up with insurance companies regarding application status and pending requests.
Track provider licenses, certifications, malpractice insurance, and other credentials.
Identify and resolve issues or missing information that may delay enrollment.
Maintain accurate records of provider and group enrollment information.
Verify provider network participation, effective dates, and payer affiliations.
Communicate with providers, practice managers, and insurance representatives regarding credentialing requirements.
Prepare professional status updates, follow-up emails, and credential reports.
Ensure applications are completed and submitted within required deadlines and payer guidelines.
Coordinate with the EDI team to ensure providers are properly enrolled before claims are submitted.
Assist with ERA/EFT enrollment when required as part of the payer enrollment process.
Maintain confidentiality of provider and client information in accordance with HIPAA and company policies.

Qualifications/skills