Jamil Ahmed

Sr. Credentialing Specialist

Medical Consultation • Tiempo completo

May 2021 - Present • 5 yrs 5 mos

Managed end-to-end healthcare provider credentialing and enrollment for physicians, healthcare providers, clinics, and medical groups. Responsible for initial credentialing, recredentialing, CAQH profile management, Medicare, Medicaid, and commercial payer enrollment. Prepared, submitted, tracked, and followed up on provider enrollment applications with multiple insurance payers. Managed NPI, NPPES, PECOS, payer portal updates, provider demographic changes, additions, terminations, revalidations, and enrollment status. Verified provider licenses, DEA certificates, board certifications, malpractice insurance, education, work history, NPI information, and other required credentials. Maintained complete and accurate provider files, credentialing records, and expiration trackers to ensure timely renewals and recredentialing. Managed CAQH profile updates, re-attestations, document uploads, provider information, and payer-related changes. Communicated with insurance companies, payer representatives, providers, and practice managers to resolve missing information, application issues, and credentialing delays. Handled Medicare and Medicaid enrollment, commercial insurance paneling, payer follow-ups, credentialing applications, and provider participation updates. Supported credentialing audits, compliance requirements, documentation reviews, and enrollment reporting. Worked closely with billing, revenue cycle, and administrative teams to resolve payer enrollment issues and support accurate provider information. Monitored credentialing deadlines and followed up with payers to help prevent unnecessary enrollment delays. Maintained organized credentialing workflows while ensuring accuracy, confidentiality, timely processing, and professional communication throughout the provider enrollment process. Assisted in improving credentialing processes and supported junior staff with application preparation, payer requirements, documentation, and follow-up procedures.