Credentialing Specialist

2 weeks ago

Manila, National Capital Region, Philippines Sysgen RPO, Inc. Full time ₱900,000 - ₱1,200,000 per year

Position: Credentialing Specialist

Work Set up: 100% WFH

Equipment: To be provided by the client

About the Job

The Credentialing Specialist will be required to complete the credentialing, re-credentialing, and payor enrollment processes for providers with contracted insurance companies and other accrediting entities. In addition, they will maintain current data for each provider to ensure timely renewal of credentialing, licensing, and certification.

Key Responsibilities

  • Review and process providers' initial applications and supporting documentation to identify possible issues. Follow up with healthcare provider as needed to obtain missing information.
  • Complete and process payer enrollment applications for healthcare providers for Medicare, commercial managed care, and other identified plans in the market.
  • Complete timely follow-up on all-payer enrollment applications.
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and credentialing software.
  • As directed, provide updated demographic information with supporting documents to outside stakeholders, such as commercial managed care plans and contracted billing entities.
  • Completing and coordinating paperwork for ERA, EDI, and EFT between the organization and payers.
  • Ensure that re-credentialing is completed timely to prevent any lapse in enrollment.
  • Monitor and maintain current expirable documents (License, DEA, Board Certifications, Malpractice).
  • Terminating enrollment with government and commercial payers upon resignation or termination of providers.
  • Complete primary source verification and prepare files for committee review.
  • Establish and maintain long-term working relationships with payors.
  • Maintains confidentiality of provider information.

Requirements

  • Associate's Degree or 3 years of credentialing experience.
  • Excellent verbal and written communication.
  • Detail Oriented
  • Have the ability to manage workflow to meet deadlines.
  • Able to work as part of a team and independently.
  • Self-motivated to achieve goals.
  • Outside-the-box thinkers; and excellent at problem-solving.
  • Enthusiastic about being part of an organization that recognizes your talent.
  • Ability to maintain consistent contact with healthcare providers and insurance companies to ensure that expectations are clear and requirements are completed in a timely manner.
  • Experience working with credentialing software, eVIPs, preferred.

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