Credentialing & Payer Enrollment Specialist (CVO) - Remote

11 hours ago

Work from Home, Philippines Neolytix LLC Full time

Position Title: Credentialing & Payer Enrollment Specialist (CVO)

Department: Credentialing Operations

Reports To: Director of Credentialing / VP of Operations

Location: Remote — Philippines

Employment Type: Full-time

Target Start Date: March 1, 2025

Position Summary

The CVO Documentation & Audit Specialist will lead the preparation, documentation, and compliance efforts required for NCQA CVO Certification. This is a critical hire for an accelerated certification timeline targeting Q The role involves developing and maintaining credentialing policies and procedures aligned with NCQA standards, conducting internal audits, preparing documentation for survey submission, and ensuring ongoing compliance with certification requirements.

Key Responsibilities

  • NCQA Documentation & Compliance (50%)
  • Develop, write, and maintain credentialing policies and procedures aligned with NCQA CVO standards
  • Cross-reference all policies and procedures to specific NCQA standards and elements
  • Prepare and organize documentation for Interactive Review Tool (IRT) submission
  • Track and monitor NCQA policy updates, corrections, and clarifications
  • Quality Improvement & Audit (30%)
  • Establish and maintain quality improvement (QI) processes as required by NCQA
  • Conduct internal file audits (10-20% of closed files) to ensure compliance
  • Prepare mock survey materials and conduct internal readiness assessments
  • Collect and analyze QI metrics and prepare reports for certification review
  • Survey Preparation & Support (20%)
  • Coordinate survey submission timeline and requirements
  • Prepare file samples for NCQA surveyor review
  • Support virtual survey logistics and documentation requests
  • Address surveyor findings and coordinate corrective action responses

Required Qualifications

  • 4-6 years of experience in healthcare credentialing or CVO operations
  • Direct experience with NCQA credentialing standards (CVO or CR) — REQUIRED
  • Experience preparing for and/or participating in NCQA surveys or health plan audits
  • Strong policy and procedure writing skills
  • Proficiency with credentialing software (CAQH, VerityStream, Cactus, or similar)
  • Excellent English written and verbal communication

Preferred Qualifications

  • CPCS (Certified Provider Credentialing Specialist) or CPMSM certification from NAMSS
  • Experience with delegated credentialing arrangements
  • Prior work at an NCQA-certified CVO
  • Familiarity with JCAHO, CMS, and state credentialing requirements

Job Type: Full-time

Pay: Php50, Php100,000.00 per month

Benefits:

  • Opportunities for promotion
  • Work from home

Application Question(s):

  • Do you have experience in preparation, documentation, and compliance for NCQA CVO Certification?
  • Do you have experience preparing for and/or participating in NCQA surveys or health plan audits?
  • What credentialing software/app do you have experience on?
  • Previous salary
  • Expected Salary

Work Location: Remote

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