Credentialing Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Oversee the credentialing and enrollment applications for providers with both commercial and government health plans.

• Submit, monitor, and follow up on applications for provider credentialing and payer enrollment.

• Ensure accurate provider and enrollment data is maintained across internal systems and payer portals.

• Track application statuses, identify missing documents or information, and address enrollment challenges.

• Liaise with payers and providers to gather necessary documentation and rectify credentialing discrepancies.

• Conduct regular follow-ups with payers to confirm that applications are advancing within expected timelines.

• Investigate payer requirements, participation criteria, and enrollment procedures.

• Maintain comprehensive records of credentialing activities, effective dates, and payer communications.

• Raise complex credentialing or enrollment issues as necessary.

• Assist the Credentialing team with special projects and initiatives for process enhancement.

⛳️ Requirements

• A bachelor’s degree or equivalent experience is required.

• Prior experience in healthcare credentialing, provider enrollment, medical billing, healthcare operations, or a related field is preferred.

• A solid understanding of provider credentialing and payer enrollment procedures is advantageous.

• Exceptional attention to detail and organizational abilities are essential.

• Strong verbal and written communication skills are necessary.

• Effective problem-solving skills and the ability to follow through are important.

• Proficiency in MS Office, Google Workspace, and business systems is required.

• Comfortable navigating spreadsheets, databases, and various web-based payer portals.

• Capability to handle multiple priorities and meet deadlines in a dynamic remote environment is essential.

• Self-driven, reliable, and capable of working independently.

• Willingness and ability to work during United States East Coast (ET) hours.

• Must reside in the Philippines.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Opportunities for professional development and training.

• Flexible working hours in a remote work environment.

• Supportive team culture focused on collaboration and growth.