Provider Credentialing Specialist

4 days ago

Pasay, National Capital Region, Philippines Infinit-O Full time $40,000 - $60,000 per year

Key Responsibilities:

Position Summary -

We are seeking a highly organized and detail-oriented Credentialing Associate to support the initial and re-credentialing processes for our licensed healthcare providers. This role requires meticulous data management and a commitment to regulatory compliance.

Key Responsibilities -


• Application Management: Assist with the full lifecycle of credentialing and re-credentialing applications, ensuring timely and accurate submission.


• Primary Source Verification (PSV): Perform meticulous PSV of licenses, certifications, education, and other required documents using appropriate verification databases (e.g., NPDB, OIG).


• Database Integrity: Accurately input and maintain up-to-date provider data in the credentialing software (e.g., Cactus, Symplr).


• Communication & Follow-Up: Serve as a primary point of contact for providers and external sources to obtain missing or incomplete documentation.


• Compliance: Ensure all activities adhere to internal policies and external standards (e.g., NCQA, The Joint Commission).


• Committee Support: Prepare organized and complete provider files for committee review.

Requirements

Required:


• Education: High school diploma or equivalent.


• Skills: Proficiency in Microsoft Office Suite (Word, Excel) and an understanding of Primary Source Verification (PSV) concepts.


• Attributes: Exceptional attention to detail, strong organizational ability, and effective written and verbal communication skills.

Preferred:


• Experience: Minimum of one (1) year of direct experience in healthcare credentialing, provider enrollment, or a highly related compliance/administrative role.


• Experience using a dedicated credentialing software platform (e.g., Cactus, Symplr).


• Knowledge of NCQA or The Joint Commission standards.


• Associate's or Bachelor's degree in a related field.

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