Company: The Inventor Solutions
Location: Rawalpindi, Pakistan
Job Type: Full-Time | On-Site | Night Shift
Department: Healthcare Operations/Revenue Cycle Management

About the Role

The Inventor Solutions is looking for an experienced Senior Credentialing Specialist to manage end-to-end provider credentialing, re-credentialing, payer enrollment, and provider data maintenance for our U.S.-based healthcare clients.

The ideal candidate should have strong hands-on experience working with physicians, individual providers, group practices, healthcare facilities, Medicare, Medicaid, commercial insurance payers, CAQH, NPPES, and PECOS.

This is a senior-level position requiring independent ownership of credentialing cases, strong payer follow-up, problem-solving ability, and the capability to manage multiple providers and enrollment processes simultaneously.

Key Responsibilities

• Manage complete provider credentialing and re-credentialing processes from initiation through approval.
• Handle enrollment of physicians and healthcare providers with Medicare, Medicaid, and commercial insurance payers.
• Manage individual provider, group practice, and facility-related credentialing and enrollment processes.
• Create, maintain, update, and attest provider profiles in CAQH.
• Manage provider information, NPI records, taxonomy codes, and updates through NPPES.
• Handle Medicare enrollments, reassignments, changes, and updates through PECOS.
• Process new provider enrollments, provider additions, group affiliations, location additions, demographic changes, and terminations.
• Track credentialing and enrollment applications from submission through payer approval and effective date.
• Conduct timely and consistent follow-ups with insurance companies and payer representatives.
• Resolve application deficiencies, credentialing delays, payer discrepancies, and enrollment-related issues.
• Verify and maintain provider documentation including:
  • State licenses
  • DEA registrations
  • Board certifications
  • Malpractice insurance
  • Education and training records
  • Work history
  • Hospital affiliations
  • Other payer-required documentation
• Monitor expiration dates and ensure licenses, certifications, and credentials remain current.
• Maintain accurate credentialing trackers, payer records, application statuses, effective dates, and supporting documentation.
• Coordinate with providers, practice managers, billing teams, payer representatives, and internal operations teams.
• Support payer contracting and network participation processes where required.
• Handle provider roster updates and payer demographic maintenance.
• Identify credentialing gaps that may impact claims submission, reimbursement, or provider participation.
• Prepare credentialing status reports for management and clients.
• Escalate high-risk or significantly delayed applications and recommend appropriate corrective action.
• Review credentialing work for accuracy and completeness before submission.
• Provide guidance and support to junior credentialing team members where required.

Required Qualifications

• 3+ years of hands-on experience in U.S. healthcare credentialing and provider enrollment.
• Strong working knowledge of:
  • CAQH
  • NPPES
  • PECOS
  • Medicare
  • Medicaid
  • Commercial insurance payer portals
• Experience credentialing physicians and healthcare providers within the U.S. healthcare system.
• Strong understanding of individual, group, and multi-location provider enrollment.
• Experience managing credentialing cases independently from initiation to completion.
• Experience communicating directly with U.S. insurance companies and payer representatives.
• Good understanding of NPI, taxonomy, provider affiliations, group reassignment, payer enrollment, and effective-date management.
• Excellent written and verbal English communication skills.
• Strong organizational, analytical, and problem-solving abilities.
• High attention to detail and accuracy.
• Ability to manage multiple providers, applications, and deadlines simultaneously.
• Proficiency in Microsoft Excel, Google Sheets, and web-based healthcare systems.

Preferred Experience

Preference will be given to candidates with experience in:

• Multi-specialty medical practices
• Physician and advanced practice provider credentialing
• Group and facility enrollments
• Medicare and Medicaid enrollment
• Commercial payer credentialing
• Multi-state provider credentialing
• Payer contracting and network participation
• Provider roster management
• Credentialing audits and compliance
• Revenue Cycle Management (RCM)
• Training or supervising junior credentialing staff

What We Are Looking For

We are looking for a professional who can take ownership of credentialing operations, rather than simply process applications.

The successful candidate should be:

• Highly organized and detail-oriented
• Strong in payer communication and follow-up
• Capable of independently resolving complex credentialing issues
• Proactive in identifying enrollment risks and delays
• Comfortable managing a high volume of credentialing cases
• Accountable for timelines, accuracy, and application completion
• Professional when communicating with U.S.-based providers, clients, and insurance representatives
• Capable of guiding junior credentialing resources when required

Why Join The Inventor Solutions?

The Inventor Solutions works with U.S.-based healthcare organizations across various specialties, providing healthcare operations and Revenue Cycle Management support.

As a Senior Credentialing Specialist, you will have the opportunity to work across different provider types, payers, specialties, and healthcare organizations while developing deeper expertise in the U.S. healthcare ecosystem.

We offer a professional, growth-focused environment with opportunities for career progression, leadership responsibilities, learning, and performance recognition.

Apply now to join The Inventor Solutions as a Senior Credentialing Specialist and become a key part of our growing U.S. Healthcare Operations team.