Provider Credentialing Specialist

2 days ago

Manila, National Capital Region, Philippines Unlock HBA Full time $40,000 - $80,000 per year

This is a remote position.

Virtual Rockstar is seeking a highly organized and detail-oriented Credentialing Specialist to join our client's pediatric therapy team. In this role, you will manage the full credentialing and provider enrollment process for healthcare professionals across both Medicaid and commercial insurance plans.

This is a critical support role that ensures providers are enrolled and credentialed promptly so they can deliver care to patients without administrative delays.

About Our Client 

Virtual Rockstar is hiring on behalf of a pediatric therapy practice located in Arizona. This client provides occupational, physical, speech, feeding, and ABA therapy services, along with other developmental programs that support children with special needs.

The company's mission is simple yet powerful: to help kids reach their greatest potential. Their highly qualified therapists design and implement individualized goals, using one-on-one sessions, co-treatment across disciplines, and group settings to ensure every child gets the personalized care they deserve.

As a family-owned and locally operated practice, the client values compassion, teamwork, and a strong commitment to serving families in their community.

Responsibilities

  • Oversee and manage the provider enrollment process for all insurance plans (commercial and Medicaid).

  • Prepare and submit enrollment applications, revalidation requests, and updates.

  • Complete credentialing tasks, including:

    • NPI enrollments

    • APEP enrollment

    • CAQH enrollment, updates, attestations

    • Disclosures of ownership

  • Communicate with healthcare providers, insurance companies, and government agencies to ensure timely processing.

  • Assist providers with completing enrollment forms and meeting payer-specific requirements.

  • Maintain and update provider records (status, effective dates, revalidation timelines, documentation).

  • Follow up with payers to track applications, address inquiries, and meet deadlines.

  • Ensure compliance with Medicaid and commercial payer standards, as well as internal policies.

  • Stay current on Medicaid and commercial payer requirements.

  • Perform additional job-related duties as needed.

Requirements

  • Prior experience in credentialing, provider enrollment, or medical administration (preferably in pediatrics, therapy services, or a multi-provider practice).

  • Knowledge of commercial and Medicaid credentialing requirements.

  • Proficiency with credentialing portals such as CAQH, Optum, and state-specific systems like AZ AHCCCS.

  • Strong organizational skills with the ability to manage multiple tasks and deadlines.

  • Excellent written and verbal communication skills.

  • Ability to work independently and proactively manage credentialing timelines.

  • High attention to detail and accuracy.

Preferred (Nice to Have):

  • Experience credentialing OTs, PTs, SLPs, BCBAs, and RBTs.

  • Familiarity with tools such as and Paylocity.

  • Previous experience supporting a therapy or healthcare provider team.

Benefits

  • Competitive salary commensurate with experience.

  • Opportunities for professional development and growth.

  • Work in a dynamic and supportive team environment.

  • Make a meaningful impact by helping to build and strengthen families in the Philippines. 

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