Medical Credentialing Expert

Cognitive Healthcare International; Pakistan; On-site; PKR 16,616,000 - 24,924,000; Full time

Job summary

Cognitive Healthcare International in Pakistan seeks a meticulous Credentialing Specialist to manage the full lifecycle of provider credentialing and re-credentialing for US practices, including NPI registration and CAQH maintenance, with precise, confidential handling of data.

You will submit applications to payers, monitor status, resolve denials, and ensure compliance with state and federal rules, leveraging CAQH, PECOS, and enrollment portals.

Qualifications

• Minimum of 5 years in medical credentialing and provider enrollment.
• Experience with end-to-end insurance paneling and re-credentialing in US healthcare.
• Familiarity with state/federal regulations and payer portals.

Responsibilities

• Manage full lifecycle of credentialing and re-credentialing, including NPI registration and CAQH maintenance.
• Submit applications to payers, monitor status, resolve denials, and ensure compliance.

Skills

CAQH

PECOS

NPPES

Availity

Epic

Cerner

Athenahealth

eClinicalWorks

Organizational skills

Written communication

Confidentiality

Education

Bachelor's degree in Healthcare Administration

CPCS

CPMSM

Job description

About The Role

A meticulous and detail-oriented specialist with a deep understanding of the healthcare administrative landscape, this candidate thrives on navigating complex regulatory requirements. They possess a proactive mindset, aiming to bridge the gap between healthcare providers and insurance networks to ensure seamless revenue cycles.

About The Role

A meticulous and detail-oriented specialist with a deep understanding of the healthcare administrative landscape, this candidate thrives on navigating complex regulatory requirements. They possess a proactive mindset, aiming to bridge the gap between healthcare providers and insurance networks to ensure seamless revenue cycles.

Experience

• The ideal candidate must have a minimum of 5 years of dedicated experience in medical credentialing and provider enrollment.
• This background should include extensive work with diverse medical specialties, high-volume group practices, and independent clinics, with a proven track record of managing end-to-end insurance paneling and re-credentialing cycles within the US healthcare sector.

Key Responsibilities

• You will manage the full lifecycle of provider credentialing and re-credentialing, including NPI registration, CAQH profile maintenance, and PECOS/Medicare enrollment.
• Daily duties involve submitting accurate applications to commercial and government payers, monitoring application status via payer portals, resolving credentialing-related claim denials, and ensuring all provider documentation remains compliant with state and federal regulations.

Required Skills

• Technical mastery of CAQH, PECOS, NPPES, and Availity is essential, alongside proficiency in EHR/PM systems such as Epic, Cerner, Athenahealth, and eClinicalWorks.
• Soft skills must include exceptional organizational capabilities, precise written communication for high-stakes correspondence with insurance carriers, and the ability to handle sensitive provider data with absolute confidentiality.

Education & Certification

• A Bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred.
• Candidates should hold relevant industry certifications such as the Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) to demonstrate technical mastery.

Additional Requirements

• Beyond the core experience, we value candidates with a deep understanding of state-specific Medicaid nuances, experience in multi-state licensing verification, and a history of utilizing Office Ally or Practice Fusion for streamlined document management.
• Bilingual capabilities and advanced proficiency in Microsoft Excel for reporting are highly desirable.