Medical Credentialing Specialist

KGF Health LLC; Lahore; On-site; PKR 600,000 - 1,200,000; Full time

Job summary

KGF Health LLC is seeking a highly organized Medical Credentialing Specialist to join our revenue cycle management team in Lahore, Pakistan. You will manage the end-to-end credentialing and enrollment for a diverse network of healthcare providers, ensuring compliance and timely payor interactions.

The ideal candidate has hands-on Medicare PECOS and Medicaid enrollment experience, deep CAQH, NPI registry familiarity, and meticulous attention to detail.

Qualifications

• 2–3 years of direct experience in medical credentialing and provider enrollment.
• Mandatory: hands-on Medicare (PECOS) and Medicaid enrollment experience.
• Strong working knowledge of CAQH, NPI, and state medical board licensing.
• Meticulous attention to detail and strong organizational skills.
• Excellent written and verbal communication skills.
• Ability to work independently and navigate payer portals.

Responsibilities

• Manage the complete credentialing, re-credentialing, and enrollment process for providers with commercial networks and government payers.
• Prepare, submit, and track initial and re-validation applications for Medicare (PECOS) and state Medicaid programs.
• Create, update, and maintain provider profiles in CAQH and the NPPES NPI Registry.
• Monitor application statuses, follow up with insurance payers to resolve delays, and troubleshoot denials or discrepancies.
• Track and maintain provider licenses, DEA certificates, malpractice insurance, and board certifications.
• Maintain accurate provider rosters and internal credentialing databases for clean claim submission.
• Communicate documentation requirements and status updates to providers, practice managers, and insurance representatives.

Skills

Attention to detail

Organizational skills

Communication skills

Independent work

Payer portals

Education

Certified Provider Credentialing Specialist (CPCS)

Tools

CAQH

PECOS

NPPES/NPI Registry

Credentialing software

Job description

We are seeking a highly organized and detail-oriented Medical Credentialing Specialist to join our revenue cycle management team. The ideal candidate will be responsible for managing the end-to-end credentialing and provider enrollment process for a variety of healthcare providers. A deep understanding of government payers is critical for this role, requiring proven, hands-on experience specifically with Medicare and Medicaid enrollments.

Key Responsibilities

• Manage the complete credentialing, re-credentialing, and enrollment process for healthcare providers with both commercial insurance networks and government payers.
• Prepare, submit, and track initial and re-validation applications for Medicare (via PECOS) and state Medicaid programs.
• Create, update, and maintain accurate provider profiles in CAQH and the NPPES NPI Registry.
• Monitor application statuses, proactively follow up with insurance payers to resolve delays, and troubleshoot any enrollment denials or discrepancies.
• Track and maintain up-to-date records for provider licenses, DEA certificates, malpractice insurance, and board certifications to prevent coverage lapses.
• Maintain accurate provider rosters and internal credentialing databases, ensuring the billing team has the current effective dates for clean claim submission.
• Communicate clearly with providers, practice managers, and insurance representatives regarding documentation requirements and status updates.

Required Qualifications

• Minimum of 2 to 3 years of direct experience in medical credentialing and provider enrollment.
• Mandatory: Extensive, hands-on experience processing Medicare (PECOS) and Medicaid applications. Candidates without this specific experience will not be considered.
• Strong working knowledge of CAQH, NPI, and state medical board licensing requirements.
• Meticulous attention to detail and strong organizational skills to manage multiple provider files and tight deadlines simultaneously.
• Excellent written and verbal communication skills.
• Ability to work independently and navigate complex payer portals.

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) certification is a strong plus.
• Experience credentialing across multiple states or diverse medical specialties (e.g., Pediatrics, Family Medicine, Internal Medicine).
• Familiarity with standard EMR/EHR systems and credentialing software.

What We Offer

• Competitive salary based on experience
• Flexible working environment
• Opportunities for professional growth and skill advancement