Senior Credentialing Specialist

2 weeks ago

Makati City, National Capital Region, Philippines MCVO Talent Outsourcing Services Full time ₱288,000 - ₱600,000 per year

Job Description:

Purpose - Credentialing Specialist supports the accurate and timely credentialing and recredentialing

of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves

assisting the Senior Credentialing Specialist in maintaining compliance, ensuring accurate documentation, and

coordinating with insurance networks and other credentialing entities.

Key Responsibilities

Credentialing and Recredentialing Support:

  • Prepare, submit, and track provider enrollment applications for insurance networks and credentialing organizations.
  • Ensure the accuracy and completeness of provider credentialing documentation, including licenses,

    certifications, and insurance coverage.
  • Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.

    Compliance and Documentation:
  • Perform primary source verifications as directed, maintaining adherence to regulatory and organizational

    standards.
  • Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.
  • Conducts audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.

    Communication and Coordination:
  • Act as a liaison between the healthcare providers, and external entities to resolve credentialing-related issues.
  • Follow up with providers, payers, and clearinghouses to gather required information or clarify discrepancies.
  • Communicate updates on credentialing processes and progress to the Senior Credentialing Specialist and

    management.

Administrative Support:

  • Provide support during high-volume credentialing periods, including managing overflow tasks as assigned
  • Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.
  • Assist in training new team members on credentialing processes and software.

Required Knowledge and Skills:

  • End to end credentialing processes and healthcare regulations.
  • Experience in creating accounts in CAQH
  • Strong organizational skills with exceptional attention to detail and accuracy.
  • Proficiency in credentialing software and Microsoft Office Suite (Word, Excel, Outlook).
  • Excellent verbal and written communication skills for interacting with internal and external departments.
  • Ability to multitask and work collaboratively in a fast-paced environment.

    Additional Requirements
  • Education: College or equivalent required; an Associate's degree in healthcare administration or a related field is preferred.
  • Experience:

    o At least 1-3 years of administrative experience, preferably in healthcare or credentialing.

    o Familiarity with credentialing software and US payer processes is an advantage.
  • Attributes: Proactive, team-oriented, and capable of handling sensitive information professionally.

Work Environment

  • Office-based or remote, depending on organizational needs.
  • May require flexibility during high-demand periods to meet deadlines.

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