Credentialing Specialist up to 35K

4 days ago

Taguig, National Capital Region, Philippines HRTX Recruitment Full time

A Credentialing Specialist is responsible for verifying that doctors, nurses, and other healthcare providers have the proper licenses, qualifications, and background to work in a medical organization. They ensure all provider information is accurate, up-to-date, and compliant with regulations before the provider can start seeing patients.

They support onboarding (when providers join) and offboarding (when providers leave), and they follow strict procedures and medical staff bylaws to maintain high-quality credentialing standards.

Key Responsibilities

1. Perform initial and re-credentialing

They check all the documents and qualifications of new providers and repeat the process regularly for existing ones (re-credentialing).

This includes verifying:

  • Licenses
  • Certificates
  • Education
  • Work history

2. Do Primary Source Verification (PSV)

They confirm every credential directly from the original source.

Example: Contacting a university to confirm a doctor really graduated from there.

3. Help with compliance audits

They support the Credentialing Manager in auditing healthcare partners or delegated entities to make sure they comply with regulations.

They also prepare reports with findings and recommendations.

4. Improve policies and procedures

With leadership, they help review and enhance credentialing processes to make them more efficient and compliant.

5. Monitor expiring documents

They track licenses, certifications, and insurance documents to ensure nothing expires.

They re-verify these on time to prevent compliance issues.

6. Process provider applications

They handle the full application process for providers:

  • Collect documents
  • Follow up on incomplete applications
  • Escalate issues to the Medical Staff Office
  • Prepare provider profiles for committee review

7. Update provider information

They ensure provider data is accurate across systems, including:

  • Demographics
  • Practice locations
  • Contact info

They follow strict data privacy and accuracy standards.

8. Process system access requests

They may help grant or remove access for providers (e.g., EHR systems).

Education & Experience Requirements Required

  • High School diploma or GED
  • Strong understanding of healthcare regulations (preferred)

Preferred

  • Bachelor's degree in Business, Healthcare, or related field
  • 1 year experience in:
  • Medical staff services
  • Credentialing Verification Organizations (CVO)
  • HR background checks in medical field
  • Certifications:
  • CPCS (Certified Professional Credentialing Specialist)
  • CPMSM (Certified Professional Medical Staff Management)

Job Types: Full-time, Permanent

Pay: Php28, Php35,000.00 per month

Benefits:

  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training

Experience:

  • Medical staff services: 1 year (Required)
  • Credentialing Verification Organizations (CVO): 1 year (Required)
  • HR background checks in medical field: 1 year (Required)

Work Location: In person

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