Credentialing Specialist

9 hours ago

Work from Home, Philippines MCVO Full time

Purpose - The Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.

Key Responsibilities

Credentialing and Recredentialing Support:

  • Preparing, submitting, and tracking 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.
  • Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.

Communication and Coordination:

  • Act as a liaison with 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 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:

  • Knowledge of credentialing processes and healthcare regulations.
  • 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.
  • At least 5 years of administrative experience, preferably in healthcare credentialing.
  • Experienced with credentialing software such as CAQH and US payer processes
  • Proactive, team-oriented, and capable of handling sensitive information professionally.

Work Environment

  • Remote work
  • May require flexibility during high-demand periods to meet deadlines.

Shift / Hours:

Night Shift: Monday – Friday, 9:00 PM PHT – 6:00 AM in PHT.

For faster processing of your application, please submit your resume through this link:

Job Type: Full-time

Benefits:

  • Company Christmas gift
  • Health insurance
  • Work from home

Experience:

  • CAQH: 1 year (Required)
  • Hospital Priveleging: 1 year (Preferred)
  • Provider Enrollment: 1 year (Required)
  • Facilities Enrollment: 1 year (Required)
  • Credentialing: 3 years (Required)

Work Location: Remote

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