WFH - Medical Clinic Credentialer

1 week ago

Manila, National Capital Region, Philippines BruntWork Full time ₱40,000 - ₱60,000 per year

Job Overview

We are seeking a detail-oriented and experienced Credentialing Coordinator to join our team. The ideal candidate will play a key role in ensuring that our clinics are successfully credentialed and contracted with insurance payers. This individual will be responsible for navigating the credentialing and contracting process with precision, maintaining compliance with payer requirements, and facilitating favorable contract negotiations.

Job Highlights

  • Paid Hours per Week: 20
  • Schedule: Monday to Friday, 1 PM to 5 PM | Eastern Time
  • Work Arrangement: Work from home
  • Contract: Independent Contractor

Side note: Since this is a permanent work-from-home position and an "Independent Contractor" arrangement, the candidates must have their own computer and internet connection. They will handle their own benefits and taxes. The professional fees are on hourly rates and the rate depends on your performance in the application process.

Key Responsibilities:

Credentialing

  • Manage and complete the credentialing process for providers and clinics with insurance companies.
  • Maintain and update provider and clinic information in payer systems and internal databases.
  • Ensure timely submission and follow-up of all required documents to meet payer deadlines.

Contracting

  • Facilitate the contracting process between the clinic and insurance payers.
  • Review and analyze contract terms to ensure alignment with clinic goals and compliance with regulations.
  • Negotiate terms, reimbursement rates, and other contract details to secure favorable agreements.

Payer Relations

  • Serve as the primary liaison between the clinic and insurance payers during the credentialing and contracting process.
  • Resolve issues and discrepancies promptly to avoid delays in network inclusion.
  • Build and maintain positive relationships with payer representatives.

Compliance and Record-Keeping

  • Ensure compliance with federal, state, and payer-specific guidelines throughout the credentialing and contracting process.
  • Maintain organized records of all applications, contracts, and correspondence.
  • Monitor and update credentialing and contract renewal timelines to prevent lapses.

Collaboration and Communication

  • Work closely with clinic leadership and other administrative staff to align credentialing and contracting activities with clinic objectives.
  • Provide regular updates on credentialing status and contracting progress.

Requirements

  • Experience: Minimum of 1-2 years in medical credentialing, contracting, or payer relations, preferably in a clinical setting.

Skills:

  • Strong understanding of insurance credentialing and contracting processes.
  • Excellent negotiation and communication skills.
  • Proficient in managing multiple tasks and meeting deadlines.
  • Attention to detail and a high level of organization.
  • Technical Proficiency: Familiarity with payer portals, credentialing software, and Microsoft Office Suite.

Independent Contractor Perks

  • Permanent work from home
  • Immediate hiring

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