Sr Credentialing Specialist

2 weeks ago

Mandaluyong City, National Capital Region, Philippines MedRisk LLC Full time ₱900,000 - ₱1,200,000 per year

Position Summary

Senior Credentialing Specialist have a critical role within the Provider Management team. This role is responsible for the creation of new sites as well as entering contractual pricing. This team is responsible for a variety of tasks that goes from initial credentialing to manage demographic information for all our network, including our Corporate Providers. Detail oriented is a must as this role is responsible for entering pricing and it impacts the Company's revenue.

Primary Duties & Responsibilities

  • Validates demographic information for all providers and ensures accuracy of managed provider data.
  • Creates and updates accounts, contracts, pricing, exclusions, etc. according to information received internally and externally.
  • Work Inquiry logs to resolve provider demographic changes as presented.
  • Strong internal and external communication via phone and email with all provider groups, including our Corporate providers to obtain critical information to update our network database.
  • Assist Compliance team with urgent client audits by obtaining information necessary to credential providers.
  • Ensure all necessary documentation is received in accordance with our Policy and Procedures for Initial Credentialing and re-credentialing.
  • Validate clinician licenses and certifications for accuracy and to confirm within good standing with appropriate agencies.
  • Work on requests for Tax Identification Number changes from providers
  • Work on other assigned projects specified by Provider Management leadership as needed.
  • Consistently meet or exceed expectations for data entry accuracy.
  • Other duties as needed.

Qualifications

  • Bachelor's degree, or equivalent education and experience.
  • Excellent communication, organizational, and problem-solving skills.
  • Proven ability to multitask and manage time effectively.
  • Microsoft Office Skills (Word, Excel, PowerPoint, Outlook) Basic Proficiency.
  • Attention to detail and ability to establish and meet deadlines.

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