Credentialing/Health Insurance Advocate

2 weeks ago

Manila, National Capital Region, Philippines Private Advertiser Full time

Position:Credentialing / Health Insurance Advocate

Location:Eastwood Libis Quezon City

Work setup & shift:Onsite | Night Shift

CF Staffing Solutions is a leading Modern Business Process Outsourcing (BPO) company dedicated to helping you achieve unparalleled success. Our primary focus is to harness the power of outsourcing and drive your organization towards reaching its goals.

Your Role:

As aCredentialing / Health Insurance Advocate, you will:

This role is responsible for the credentialing, privileging, and licensing of practice plan faculty in compliance with regulatory and policy requirements. The position requires a high level of confidentiality and attention to detail to protect sensitive information.

Key Responsibilities:

  1. Credentialing Process Management: Initiate, coordinate, and track the acquisition of credentialing documentation from both new and existing providers. Ensure all necessary follow-ups and problem resolution are handled promptly.
  2. Document Submission: Ensure timely processing and distribution of all required credentialing documents for physicians and healthcare professionals to hospitals, licensing boards, and insurance companies (including subcontracted entities). Follow up to confirm receipt and status.
  3. Confidentiality Management: Maintain strict confidentiality of all credentialing files and databases, ensuring compliance with privacy regulations and organizational policies.
  4. Communication with Stakeholders: Serve as a liaison between physicians, credentialing agencies, insurance companies, and medical staff offices. Ensure all parties have the information they need to complete the credentialing process efficiently.
  5. Credentialing Documentation Monitoring: Develop and maintain a tracking system for credentialing documentation, ensuring all certification and licensure renewals are completed on time. Notify physicians and administration of upcoming expiration dates and required updates.
  6. Provider Directory Management: Review provider directories provided by insurance companies to ensure accuracy. Notify insurance companies of necessary corrections and follow up to ensure updates are made.
  7. Relationship Management: Foster strong, professional relationships with insurance companies, regulatory agencies, hospital medical staff, clinic managers, department chairs, physicians, and other stakeholders to ensure smooth operations.
  8. Reporting and Updates: Regularly provide updates on the status of credentialing processes, insurance contracts, and provider listings to relevant personnel, including administrators, department chairs, and billing staff.
  9. Faculty Engagement: Meet with new faculty candidates to introduce credentialing protocols and gather necessary documentation.
  10. Credentialing Software Management: Oversee the management of credentialing software (e.g., Modio or equivalent) and ensure data accuracy and efficiency within the system.

What You Need:

Non-negotiables:

  1. Bachelor's Degree in any field.
  2. Knowledge of medical provider credentialing, accreditation, regulations, and state licensing requirements.
  3. Familiar with CAQH, Medicare, Medicaid, Tricare, third-party payers, and various physician specialties.
  4. Excellent communication (written and verbal), proficiency in MS Office, and strong organizational and time management abilities.
  5. Ability to maintain confidentiality and work professionally with physicians and colleagues.
  6. Understanding of regulatory guidelines and capable of cross-training others in the credentialing process.
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