Clinical Credentialing Specialist

4 days ago


Davao City, Davao, Philippines CoolBlue VA Full time

Job Summary

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CoolBlue VA is seeking a detail-oriented Provider Credentialer to support our mental health group practice. This role ensures our therapists, counselors, and mental health professionals are properly credentialed with insurance companies and regulatory agencies.

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About the Role

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  • Manage the full credentialing lifecycle, including initial credentialing, re-credentialing, and privileging.\
  • Verify and maintain provider qualifications, licenses, malpractice insurance, and continuing education records.\
  • Coordinate with providers to collect and submit necessary documentation to insurance companies and credentialing organizations.\
  • Work with insurance companies and CAQH to ensure provider enrollment and network participation.\
  • Ensure compliance with HIPAA, Medicare, NCQA, URAC, and Florida mental health regulations.\
  • Track expiration dates for licenses and initiate re-credentialing.\
  • Resolve credentialing issues to prevent billing disruptions.\
  • Qualifications:\
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    • HIPAA Certified with 2-5 years of mental health provider credentialing experience.\
    • Strong knowledge of payer-specific requirements and mental health credentials (LCSW, LPC, LMFT, PhD/PsyD, etc.).\
    • Familiarity with insurance panels (Aetna, BCBS, Cigna, Humana, Tricare, UnitedHealthcare).\
    • Proficiency in credentialing software, Microsoft Office, and provider databases.\
    • Excellent organizational and communication skills.\
    • Must have a work-from-home setup.\
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    • Certified Provider Credentialing Specialist (CPCS) or similar certification.\
    • Experience in a mental health group practice.\
    • We're looking for a proactive, detail-oriented professional who can work with minimal supervision.\
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    • What We Offer\
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      • A competitive hourly rate of $3.5.\
      • An opportunity to work from home and enjoy a healthy work-life balance.\
      • The chance to make a meaningful impact on the lives of mental health professionals and their patients.\
      • \
      • About CoolBlue VA


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