Contracting & Credentialing Operations Manager

6 days ago


Manila, National Capital Region, Philippines The Auctus Group Full time
About the Role

We are seeking a highly skilled Contracting & Credentialing Team Lead to join our team at The Auctus Group. This role will be responsible for conducting follow-up steps until payor approval is obtained, filing provider practice change notifications, and updating NPI records.

The ideal candidate will have 1-3 years of experience in contracting and credentialing, with knowledge of organizational effectiveness and operations management. Experience in a multi-entity organization in the healthcare industry is an added advantage.

  • Key Responsibilities:
  • Conduct all follow-up steps until payor approval/completion is obtained
  • File provider practice change notifications and perform follow-up duties till confirmed complete by payors
  • Update NPI records according to provider specifications
  • Enroll providers in Medicare/Medicaid as prescribed by each program requirements
  • Track provider licensure and board expirations and ensure timely processing CAQH, and payor updates
  • Complete requests for re-credentialing for both providers and facilities
  • Accept and process all requests from payers for credentialing information/updates/new contracts and products
  • Answer questions, process requests from staff/providers related to credentialing information
  • Address enrollment disconnects regarding facility and providers
  • Complete ERA/EFT enrollment, tracking and filing, clearinghouse (Availity RCM, CAQH, Enroll hub etc.)
  • Maintain quarterly CAQH mass attestation
  • Serve as liaison between outside organizations and external customers
  • Manage the creation/maintenance of our Availity, Optum & Medicare as it pertains to usage by providers & third-party users
  • Submit accreditation applications and follow up until approval is obtained
  • Knowledge of licensing application processes across different states
  • Proficiency in creating Group NPI (GNPI) and Individual NPI (INPI) through NPPES
  • Familiarity with Modio, Pipedrive, and LastPass is a plus
  • Experience in submitting hospital privileges/initial appointment applications and managing follow-ups until approval
  • Experience in submitting and tracking DEA applications until approval
  • Experience in maintaining the Provider's CAQH


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