Credentialing Analyst

2 weeks ago

Bonifacio Global Metro Manila, Philippines John Clements Consultants, Inc. Full time ₱25,000 - ₱50,000 per year

Responsibilities:

  • Handle timely and accurate initial credentialing and re-credentialing of network practitioners, including primary source verification and other documentation requirements.
  • Support the Credentialing Manager in conducting regulatory compliance audits and preparing detailed reports with findings and recommendations.
  • Collaborate with leadership to review and enhance department policies, procedures, and quality standards.
  • Monitor expiring credentials and complete re-verifications in accordance with applicable regulations.
  • Process provider applications for initial and re-appointment; ensure completion, escalate issues as needed, and prepare profiles for review.
  • Maintain and update provider demographic information and ensure data accuracy across systems.
  • Perform proactive and reactive monitoring, quality audits, and support access requests as necessary.

Qualifications:

  • Bachelor's degree in any field.
  • At least 1 year of experience in credentialing, provider enrollment, or a similar function within healthcare, BPO, or shared services.
  • Experience in HR background checks or employment verification in the medical field.
  • Open to a hybrid work setup and night shift schedule (initially in-office during onboarding).

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