Credentialing Specialist

2 weeks ago

Manila, National Capital Region, Philippines MicroSourcing Full time

Medical Administration (Healthcare & Medical)

With more than 9,000 professionals across 11 delivery centers in the Philippines, MicroSourcing remains the country's largest provider of offshoring solutions.

Credentialing Specialist , be 100% YOU with MicroSourcing

A Credentialing Specialist is expected to:

The Credentialing Specialist will be responsible for the credentialing, privileging, licensing of practice plan faculty in accordance with established regulatory and policy requirements. This is a highly confidential position and due care is required to secure confidential information. Responsible for the timely completion and submission of required documentation for each required entity including hospitals, state and federal licensures and health plans.

  • Initiates and coordinates the acquisition and receipt of all credentialing documentation from new and existing providers; provides follow-up and problem resolution as required.
  • Coordinates processing and distribution by sending correct and complete documentation for each participating physician or healthcare professional to the appropriate hospitals, licensing boards and insurance companies (including subcontracted entities) in a timely manner and follows up on status of process.
  • Maintains and ensures strict confidentiality of files and databases.
  • Provides medical staff offices and insurance companies with everything needed to complete the credentialing process efficiently and effectively. Acts as a liaison between the physician being credentialed and agency completing the credentialing to ensure timeliness of credentialing process.
  • Develops and maintains a system to monitor all date sensitive credentialing documentation for re-certification and expiration dates to ensure maintenance of current status. Notifies physicians and administration of impending expiration dates and/or information update requests.
  • Reviews provider directories supplied by the insurance companies to ensure all provider listings are complete and correct.
  • Notifies, in writing, insurance company of any necessary corrections and follows up to ensure corrections are made.
  • Maintains good consistent oral and written communication and works to establish and maintain good business relationships with insurance companies, regulatory agencies, hospital medical staff, office personnel, clinic managers, physicians, department chairs, other WC HEALTH staff and government agencies.
  • Maintains and distributes regular written updates on the credentialing process including, but not limited to, insurance contracts by doctor list and WC HEALTH contracted insurance grid to appropriate personnel, including but not limited to, administrators, department chairs, billing and WC HEALTH administration.
  • Meets with candidates for faculty positions to establish contact and distribute credentialing protocols and information.
  • Management of Modio or other computerized credentialing software database

What it takes to be part of our team:

  • Bachelor's Degree in any field.
  • Knowledge of medical provider credentialing and accreditation principles, processes, procedures, regulations, standards, state licensing requirements and documentation.
  • Working knowledge of physician specialties and service delivery.
  • Working knowledge of CAQH, Medicare, Medicaid, Tricare, third party payers and insurance companies.
  • Ability to write reports and general business correspondence.
  • Possess strong knowledge of state, federal and local regulatory bodies and/or guidelines for credentialing.
  • Proficient in using MS Office Applications
  • Ability to cross-train others when needed to ensure continuation of credentialing process.
  • Ability to maintain confidentiality and follow regulatory guidelines. Maintains patient, providers, workplace and co-worker privacy and confidentiality.
  • Ability to work with physicians and others in a highly professional manner and maintain good working relationships.
  • Strong organizational and time management skills.
  • Amenable to work on Night Shift.
  • Amenable to Work On-Site (Eastwood)

What's in it for you?

  • Competitive Total Rewards (Compensation, HMO, Group Life Insurance and Performance bonuses)
  • A very collaborative work culture

Find a balance between work and life that fits you. Do what you do best with MicroSourcing

For more information, visit

*Terms & Conditions apply

Your application will include the following questions:

What's your expected monthly basic salary?

MicroSourcing is one of the leading offshoring and outsourcing solutions providers in the Philippines. Voted Best Non-voice Excellence Company of the Year in 2014, we are not your average BPO. We cater to foreign companies who operate in a wide variety of industries from all over the world. Therefore, you have the opportunity to do what you love and grow your career.

Our offices are located at Eastwood City, Mall of Asia Complex, Bonifacio Global City, Ortigas Center, and Cebu IT Park, all easily accessible no matter where you live. Join our growing family and be part of an international and collaborative working environment.

Visit and apply at one of our Career Hubs, Monday-Friday, 9AM-5PM with your updated resume and a valid ID:

Eastwood Career Hub - 6th Floor, 1880 Building, Eastwood City Cyberpark, Bagumbayan, Quezon City | Career Hub - 32nd Floor, Cyberscape Beta Building, Topaz Road, Ortigas Center, Pasig City | Complex Career Hub - Ground Floor, TwoE-com Center, Mall of Asia Complex, Pasay City | Career Hub - Upper Ground FLB Corporate Center, Cebu Business Park Mabolo, Archbishop Reyes Avenue, Cebu City, 6000 Cebu

MicroSourcing is one of the leading offshoring and outsourcing solutions providers in the Philippines. Voted Best Non-voice Excellence Company of the Year in 2014, we are not your average BPO. We cater to foreign companies who operate in a wide variety of industries from all over the world. Therefore, you have the opportunity to do what you love and grow your career.

Our offices are located at Eastwood City, Mall of Asia Complex, Bonifacio Global City, Ortigas Center, and Cebu IT Park, all easily accessible no matter where you live. Join our growing family and be part of an international and collaborative working environment.

Visit and apply at one of our Career Hubs, Monday-Friday, 9AM-5PM with your updated resume and a valid ID:

Eastwood Career Hub - 6th Floor, 1880 Building, Eastwood City Cyberpark, Bagumbayan, Quezon City | Career Hub - 32nd Floor, Cyberscape Beta Building, Topaz Road, Ortigas Center, Pasig City | Complex Career Hub - Ground Floor, TwoE-com Center, Mall of Asia Complex, Pasay City | Career Hub - Upper Ground FLB Corporate Center, Cebu Business Park Mabolo, Archbishop Reyes Avenue, Cebu City, 6000 Cebu

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