Healthcare Provider Credentialing Manager

2 days ago

Cebu City, Central Visayas, Philippines beBeeCredentialing Full time $40,000 - $60,000
Credentialing Specialist Position

We are seeking a skilled Credentialing Specialist to join our remote team. This role involves managing the credentialing and recredentialing processes for healthcare providers, ensuring compliance with state regulations, insurance guidelines, and national accreditation standards.

  • Manage the credentialing process for healthcare providers, including physicians, nurse practitioners, and allied health professionals.
  • Ensure all provider files comply with Maryland state regulations and insurance guidelines.
  • Complete and submit credentialing applications and enrollment forms to commercial payers and government agencies.
  • Maintain and update provider data in credentialing systems and internal databases.
  • Track and monitor expirable items such as licenses, certifications, and recredentialing deadlines.
  • Communicate effectively with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.

Key Responsibilities:

  • Prior experience in healthcare credentialing or provider enrollment, preferably with Maryland-based providers.
  • Familiarity with Maryland-specific credentialing standards, including Medicaid and regional payers.
  • Proficiency with credentialing platforms such as CAQH, PECOS, and NPPES.
  • Strong analytical and problem-solving skills, with attention to detail and ability to manage multiple deadlines.
  • Effective written and verbal communication skills, with a professional demeanor in interactions with stakeholders.

Requirements:

  • High school diploma or equivalent required; degree in a related field preferred.
  • Ability to work independently in a remote environment and maintain confidentiality of sensitive information.
  • Self-motivated and reliable, with a commitment to excellence and continuous learning.

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