Senior Credentialing Specialist

3 days ago

Work from Home, Philippines MCVO Full time $40,000 - $60,000 per year

The 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 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 between 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 Senior Credentialing Specialist and management.

Administrative Support:

  • Provide support and assigning tasks during high-volume credentialing periods
  • 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.

Key Qualifications:

  • More than 5 years of experience as Credentialing Specialist
  • Experience with CAQH required
  • Familiarity with credentialing software and US payer processes is an advantage
  • Experience in Facilities enrollment required
  • Knowledge and experience 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.
  • Good English speaker and phone voice
  • Reliable, and willing to work "night shift" in Philippines

To apply, please fill out our application form here:

Shift / Hours:

Monday – Friday in one single shift, 9:00 AM EST - 6:00 PM EST. Note this is +12 or +13 Philippine time, which will be 9:00 PM PHT – 6:00 AM in PHT.

Job Type: Full-time

Benefits:

  • Additional leave
  • Company events
  • Health insurance
  • Work from home

Experience:

  • Credentialing: 1 year (Required)
  • CAQH: 1 year (Required)
  • Facilities Enrollment: 1 year (Required)

Work Location: Remote

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