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Healthcare Credentialing Professional

2 weeks ago

Davao City, Davao, Philippines CoolBlue VA Full time

About Provider Credentialing at CoolBlue VA

CoolBlue VA is a dynamic healthcare organization looking for a skilled Healthcare Credentialing Professional to join our team. In this role, you will be responsible for managing the credentialing process for our healthcare providers, ensuring they meet the required standards for insurance companies and regulatory bodies.

The successful candidate will have a strong background in provider credentialing, with experience working with insurance panels and relevant regulations.

  • Oversee the entire credentialing process for healthcare providers, from initial application to ongoing maintenance.
  • Maintain accurate and up-to-date records of provider qualifications, including licensure, certifications, and insurance coverage.
  • Collaborate with providers to gather necessary documentation and submit it to insurance companies and credentialing entities.
  • Establish and maintain relationships with insurance companies and CAQH to facilitate smooth provider enrollment and network participation.
  • Monitor and ensure compliance with NCQA, URAC, and other accreditation standards.
  • Provide clear communication to providers regarding their credentialing status, documentation requirements, and follow-up actions.
  • Stay current on industry developments, payer requirements, and evolving credentialing standards.
  • Address credentialing-related issues, discrepancies, and disputes promptly to minimize billing disruptions.
  • Track critical deadlines for licenses, certifications, and insurance contracts to guarantee timely re-credentialing.
  • Support regular audits and internal reviews to maintain complete compliance.
  • Protect sensitive provider information in accordance with HIPAA and privacy laws.