Credentialing Specialist

4 days ago

Work from Home, Philippines Staff4Me Full time ₱600,000 - ₱1,200,000 per year

We are seeking a detail-oriented and experienced Credentialing Specialist to join our growing medical billing team. The Credentialing Specialist will be responsible for managing all aspects of provider credentialing and re-credentialing processes with insurance payers, hospitals, and medical groups. This role requires strong organizational skills, a deep understanding of healthcare credentialing requirements, and the ability to work independently in a remote setting.

Key Responsibilities:

  • Coordinate and complete initial and re-credentialing applications for healthcare providers.
  • Maintain current and accurate provider data in all systems and credentialing databases.
  • Monitor credentialing timelines to avoid lapses in privileges or payer enrollment.
  • Communicate with insurance companies, medical groups, and hospital credentialing departments to follow up on application statuses.
  • Assist with provider enrollments, group contracts, and insurance updates.
  • Provide regular updates and reports to leadership on credentialing status.
  • Resolve credentialing issues efficiently and professionally.

Requirements:

  • 2+ years of experience in healthcare credentialing and payer enrollment (medical billing experience a plus).
  • Experience credentialing providers in California, Utah and Texas.
  • Knowledge of podiatry, primary care, or multi-specialty practices.
  • Strong knowledge of commercial insurance, Medicare, and Medi-Cal enrollment processes.
  • Familiarity with CAQH, PECOS, NPPES, and provider portals.
  • Excellent attention to detail and organizational skills.
  • Ability to manage multiple credentialing files and deadlines simultaneously.
  • Strong written and verbal communication skills.
  • Proficient in Microsoft Office Suite (Excel, Word, Outlook); experience with credentialing software preferred.
  • Self-motivated and capable of working remotely with minimal supervision.
  • High school diploma or GED required; associate or bachelor's degree preferred.

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