Credentialing Specialist

2 days ago

Cagayan de Oro, Northern Mindanao, Philippines beBeeCredentialing Full time $7,200 - $7,800
Expert Credentialing Coordinator

An experienced and detail-oriented credentialing specialist is required to manage the credentialing and re-credentialing processes for clinicians and facilities.

Key Responsibilities:

  • Complete and maintain credentialing and re-credentialing applications for licensed professionals
  • Submit applications to commercial and Medicaid payers, including CAQH, NPI, PECOS, and individual payer portals
  • Track credentialing statuses, follow up on delays, and maintain regular communication with insurance companies
  • Maintain accurate records of licensure, certifications, background checks, liability insurance, and other compliance documentation
  • Coordinate start dates with HR teams to ensure clinicians are active before seeing clients
  • Ensure accuracy and timely submission of demographic updates, reassignment of benefits, and provider termination notices
  • Monitor credentialing expiration dates and initiate renewals in advance
  • Assist billing teams with credentialing-related claim denials and payer issues

Requirements:

  • Strong knowledge of credentialing processes and insurance requirements (Medicaid, private payers, CAQH, etc.)
  • Familiarity with state licensing requirements for healthcare professionals
  • Excellent organizational and time management skills
  • Strong written and verbal communication skills
  • Proficiency with EMR systems like CentralReach, Rethink, or Catalyst
  • Ability to manage sensitive information with a high level of confidentiality and accuracy
Preferred Qualifications:
  • Credentialing experience, preferably in healthcare or behavioral health

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