Credentialing Specialist

7 days ago

Makati City, National Capital Region, Philippines Pride Global Full time

The Credentialing Specialist is responsible for ensuring that healthcare providers, including physicians, nurses, and other practitioners, meet all necessary qualifications and standards to practice within the organization. The role involves managing the credentialing process from initial application to ongoing monitoring, ensuring compliance with state and federal regulations, and maintaining provider records to ensure accurate, timely, and effective documentation.

Job Responsibilities:

  • Review and process applications for new and existing providers to ensure that all credentials (licenses, certifications, education, training, and experience) are valid and meet organizational and regulatory standards.
  • Verify professional licenses, certifications, malpractice insurance, and other relevant documentation.
  • Act as the primary point of contact for providers regarding credentialing, re-credentialing, and enrollment inquiries.
  • Assist providers with any questions or issues related to their credentialing status or documentation.
  • Generate and maintain reports on the status of provider credentialing, expirations, and other relevant metrics.

Qualifications:

  • Bachelor's Degree
  • Minimum of 1 year of experience in healthcare credentialing, provider enrollment, or a related field.
  • Familiarity with credentialing software and databases.
  • Excellent written and verbal communication skills.
  • Strong attention to detail and organizational skills.
Seniority level
  • Associate
Employment type
  • Full-time
Job function
  • Human Resources
Industries
  • Human Resources Services
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