Healthcare Credentialing Specialist

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

📋 Description

• Oversee, manage, and uphold credentialing services for healthcare providers and their practices.

• Build and maintain credentialing partnerships with payers and provider networks.

• Aid providers in the preparation, processing, submission, and tracking of both paper and electronic credentialing applications along with supporting documents.

• Review documents and data within the credentialing database for quality, accuracy, and timely completion.

• Manage provider enrollment in accordance with the specific requirements of each payer.

• Sort, label, maintain, and securely archive credentialing forms, applications, and supporting documents.

• Prepare, review, and submit both initial credentialing and recredentialing applications.

• Track applications and follow up with providers and payers to ensure timely processing.

• Provide training to providers and office staff regarding credentialing applications and services.

• Engage with providers, payers, and internal stakeholders via phone, email, and chat.

• Draft, edit, and maintain credentialing documents, correspondence, and other supporting materials.

• Keep precise records throughout the credentialing process.

• Adhere to federal, state, accreditation, client, and company policies and procedures.

• Meet expectations concerning productivity, quality, attendance, and service levels.

• Safeguard the confidentiality of sensitive provider and patient information and comply with information-security protocols.

• Report any security concerns or suspicious activities.

• Perform additional duties as assigned.

⛳️ Requirements

• Preferred college degree (Associate's or Bachelor's degree).

• Minimum of 2 years of BPO healthcare experience related to provider credentialing services.

• Experience in provider credentialing and knowledge of industry-standard credentialing practices.

• Prior experience in a call center/BPO environment.

• Proficiency in Microsoft Office Suite: Word, Excel, Outlook, and PowerPoint.

• Competence in Internet-based applications and online systems.

• Familiarity with Adobe Acrobat PDF.

• Understanding of healthcare terminology, eligibility, benefits, medical and dental claims, payer processes, and provider credentialing functions.

• Exceptional analytical, organizational, time management, written, verbal, and interpersonal communication skills.

• Strong attention to detail, accuracy, and proficiency in copywriting and business writing.

• Capable of professional communication through phone, email, and chat.

• Ability to handle multiple projects and provider accounts concurrently.

• Skill in prioritizing work in a dynamic environment while ensuring accuracy.

• Capacity to address practical problems and make informed decisions with minimal standardization.

• Self-driven, adaptable, resourceful, and able to work independently with little supervision.

• Willingness to work varied shifts, including graveyard shifts, holidays, and weekends when necessary.

• Preference for candidates residing in Metro Manila or nearby provinces.

• Stable internet connection of at least 35 Mbps.

• Dedicated workspace suitable for remote work.

• Availability to start as soon as possible.

🏝️ Benefits

• Work from home flexibility.

• Equipment provided by the company.

• 13th Month Pay.

• Internet allowance.

• Health Maintenance Organization (HMO) coverage for medical and dental services.