Credentialing and Provider Enrollment Specialists

2 weeks ago

Taguig, National Capital Region, Philippines John Clements Consultants, Inc. Full time ₱400,000 - ₱600,000 per year

Responsibilities


•Responsible for timely and accurate initial credentialing and re-credentialing of affiliated network practitioners. Processes primary source verification and additional requirements.


•Assists the Credentialing Manager in conducting regulatory compliance audits of delegated healthcare entities and prepares and presents reports with findings, conclusions, and recommendations.


•In collaboration with leadership, participates in reviews and continual improvement of department policies and procedures.


•Responsible for ongoing monitoring and timely re-verification of expiring credentials in accordance with all applicable regulatory standards.


•Processes provider initial and re-appointment applications, reaches out to ensure completion, escalates to Medical Staff Office as needed, and prepares profiles for review.


•Updates provider demographic information and data changes as directed, follows appropriate guidelines regarding provider information disclosure, ensures accuracy in work and performs proactive and reactive monitoring and quality auditing as needed.


•Processes provider access requests as needed.

Qualifications

  • Bachelor's degree in any field
  • Minimum of 1 year of experience in credentialing or provider enrollment within a healthcare, BPO, or shared services environment.
  • Experience in HR background checks or employment verification in the medical field may also be considered.
  • Willing to work in a hybrid setup and flexible with work schedules

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