Credentialing Specialist
4 days ago
Purpose - The Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.
Key Responsibilities
Credentialing and Recredentialing Support:
- Preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.
- Ensure the accuracy and completeness of provider credentialing documentation, including licenses, certifications, and insurance coverage.
- Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.
Compliance and Documentation:
- Perform primary source verifications as directed, maintaining adherence to regulatory and organizational standards.
- Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.
- Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.
Communication and Coordination:
- Act as a liaison with the healthcare providers, and external entities to resolve credentialing-related issues.
- Follow up with providers, payers, and clearinghouses to gather required information or clarify discrepancies.
- Communicate updates on credentialing processes and progress to the management.
Administrative Support:
- Provide support during high-volume credentialing periods, including managing overflow tasks as assigned.
- Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.
- Assist in training new team members on credentialing processes and software.
Required Knowledge and Skills:
- Basic knowledge of credentialing processes and healthcare regulations.
- Strong organizational skills with exceptional attention to detail and accuracy.
- Proficiency in credentialing software and Microsoft Office Suite (Word, Excel, Outlook).
- Excellent verbal and written communication skills for interacting with internal and external departments.
- Ability to multitask and work collaboratively in a fast-paced environment.
Additional Requirements
- Education: College or equivalent required; an Associate's degree in healthcare administration or a related field is preferred.
- Experience:
- At least 5 years of administrative experience, preferably in credentialing.
- Experienced with credentialing software such as CAQH and US payer processes is an advantage.
- Attributes: Proactive, team-oriented, and capable of handling sensitive information professionally.
Work Environment
- Remote work
- May require flexibility during high-demand periods to meet deadlines.
Shift / Hours:
Night Shift: Monday – Friday, 9:00 PM PHT – 6:00 AM in PHT.
For faster processing of your application, please submit your resume through this link:
Job Type: Full-time
Benefits:
- Company Christmas gift
- Health insurance
- Work from home
Experience:
- CAQH: 1 year (Required)
- Hospital Priveleging: 1 year (Required)
- Provider Enrollment: 1 year (Required)
- Facilities Enrollment: 1 year (Required)
- Credentialing: 3 years (Required)
Work Location: Remote
-
Senior Credentialing Specialist
4 days ago
Work from Home, Philippines MCVO Full time $40,000 - $60,000 per yearThe Senior Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves ability in handling a team, maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other...
-
Senior Credentialing Specialist
1 week ago
Work from Home, Philippines MCVO Full time ₱600,000 - ₱1,200,000 per yearThe Senior Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves ability in handling a team, maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other...
-
HR Specialist
4 days ago
Work from Home, Philippines Frontline Medical Group, LLC Full time ₱300,000 - ₱420,000 per yearJob Summary:We are seeking an experienced HR Specialist with a strong background in Home Health recruitment to join our team. The ideal candidate will have in-depth knowledge of Massachusetts credentialing requirements, proven success hiring both W2 employees and 1099 contractors, and hands-on experience with HRIS/HRMS systems. This role requires excellent...
-
Front Desk Specialist in Healthcare
4 days ago
Work from Home, Philippines Prava Therapy Full time ₱420,000 - ₱550,000 per yearCompany DescriptionPrava Therapy empowers independent physical therapists to launch and grow thriving private practices by providing credentialing, referrals, administrative support, and cutting-edge AI-powered products.Position Type: Full-TimeCompensation: P35,000.00 to P50, per monthRole DescriptionThis is a remote role for a Front Desk Specialist at Prava...
-
Enrollment Specialist – Medical Billing
4 days ago
Work from Home, Philippines Boji Medical Billing Full time ₱300,000 - ₱360,000 per yearCredentialing SpecialistRed House Medical Billing is searching for individuals to join our team. Maintaining a clean and updated database is crucial for the success of Red House Medical Billing. All business units rely on updated and valid information to ensure our providers and clients are receiving the services they come to expect.Purpose: The Enrollment...
-
Home Health Quality Assurance Specialist
2 days ago
Work from Home, Philippines Narrable Full time ₱108 - ₱627 per yearAbout NarrableAt Narrable, we're on a mission to improve healthcare for the 82 million senior patients in their homes. As more Americans age, the demand for more convenient forms of healthcare continues to grow—with a majority of senior Americans preferring at-home treatment. And yet, existing software solutions for care providers are outdated and...
-
HR Support Specialist
4 days ago
Work from Home, Philippines DCX PH, INC. Full time ₱350,000 - ₱375,000 per yearIt's fun to work in a company where people truly BELIEVE in what they're doingWe're committed to bringing passion and customer focus to the business.Number of Openings: 1Are you a detail-oriented and service-driven professional with a passion for supporting people operations? We're looking for a Home-Based HR Support Specialist to assist with the...
-
Remote Compliance Specialist
2 weeks ago
Work from Home, Philippines FORTA Full time ₱144,000 - ₱600,000 per yearFORTA'S MISSION:Forta is clearing the path to quality healthcare by delivering the best possible outcomes with the utmost convenience. Access is limited, delivery is fragmented, and families are left waiting. We are reinventing this model to provide early, high-quality access. With 1 in 36 children [CDC, 2023] diagnosed with autism, the need has never been...
-
Controller (US Tax & Accounting Strategy)
1 week ago
Work from Home, Philippines Methodology "Made with Love" Full time ₱1,000,000 - ₱2,000,000 per yearMethodology is a rapidly scaling US-based direct to consumer meal delivery service with its own kitchen, order fulfillment, delivery operations. We aim to transform how consumers eat and live. As we bring all finance, tax, and accounting functions in-house, we are seeking a world-class solo finance leader to streamline, protect, and optimize our finances in...
-
People & Culture Specialist
2 days ago
Work from Home, Philippines Amlb Full time ₱60,000 - ₱80,000 per yearABOUT AMLBAMLB is a progressive virtual Chief Financial Officer (CFO) business that enables clients and team members to reach their potential. AMLB is growing quickly, having onboarded a portfolio of innovative clients making a real impact in a range of industries from technology to social impact. Purpose-driven and relationship-focused, we are strategic...