Credentialing and CVO Documentation Specialist

Jobtailor; Philippines; On-site; PHP 600,000 - 900,000; Full time

Job summary

Jobtailor in the Philippines seeks a credentialing policy specialist to develop, write, and maintain NCQA-aligned credentialing policies. You will cross-reference policies to NCQA standards, prepare documentation for IRT submissions, and track policy updates.

The role requires 4-6 years in healthcare credentialing, direct NCQA experience, and proficiency with CAQH, VerityStream, and Cactus. Applicants should have experience preparing for NCQA surveys or health plan audits, and excellent English

Qualifications

• 4-6 years of experience in healthcare credentialing or CVO operations.
• Direct experience with NCQA credentialing standards (CVO or CR) - REQUIRED
• Experience preparing for and/or participating in NCQA surveys or health plan audits
• Strong policy and procedure writing skills
• Proficiency with credentialing software such as CAQH, VerityStream, or Cactus

Responsibilities

• Develop, write, and maintain credentialing policies and procedures aligned with NCQA CVO standards
• Cross-reference policies and procedures to specific NCQA standards and elements
• Prepare and organize documentation for Interactive Review Tool (IRT) submission
• Track and monitor NCQA policy updates, corrections, and clarifications
• Establish and maintain NCQA-required quality improvement processes
• Conduct internal file audits covering 10-20% of closed files
• Prepare mock survey materials and conduct internal readiness assessments
• Collect and analyze QI metrics and prepare certification review reports
• Coordinate survey submission timelines and requirements
• Prepare file samples for NCQA surveyor review
• Support virtual survey logistics and documentation requests
• Address surveyor findings and coordinate corrective action responses

Skills

Policy and procedure writing

Excellent written and verbal communic.

Healthcare credentialing experience

NCQA Credentialing Standards

Education

CPCS

CPMSM

Tools

CAQH

VerityStream

Cactus

Job description

• Develop, write, and maintain credentialing policies and procedures aligned with NCQA CVO standards
• Cross-reference policies and procedures to specific NCQA standards and elements
• Prepare and organize documentation for Interactive Review Tool (IRT) submission
• Track and monitor NCQA policy updates, corrections, and clarifications
• Establish and maintain NCQA-required quality improvement processes
• Conduct internal file audits covering 10-20% of closed files
• Prepare mock survey materials and conduct internal readiness assessments
• Collect and analyze QI metrics and prepare certification review reports
• Coordinate survey submission timelines and requirements
• Prepare file samples for NCQA surveyor review
• Support virtual survey logistics and documentation requests
• Address surveyor findings and coordinate corrective action responses

Requirements

• 4-6 years of experience in healthcare credentialing or CVO operations
• Direct experience with NCQA credentialing standards (CVO or CR) - REQUIRED
• Experience preparing for and/or participating in NCQA surveys or health plan audits
• Strong policy and procedure writing skills
• Proficiency with credentialing software such as CAQH, VerityStream, Cactus, or similar
• Excellent English written and verbal communication
• CPCS or CPMSM certification from NAMSS preferred
• Experience with delegated credentialing arrangements preferred
• Prior work at an NCQA-certified CVO preferred
• Familiarity with JCAHO, CMS, and state credentialing requirements preferred
• Willingness to work on a hybrid setup at the Eastwood, Quezon City office

Core Competencies

Demonstrates expertise in developing and maintaining credentialing policies aligned with NCQA standards, along with strong analytical skills for quality improvement processes and internal audits. Proficient in coordinating NCQA survey preparations and addressing surveyor findings effectively.

Highest-signal resume keywords

• NCQA Credentialing Standards
• Policy And Procedure Writing
• Credentialing Software Proficiency
• CPCS Or CPMSM Certification
• Healthcare Credentialing Experience

ATS Optimization Keywords

Hard Skills

• Credentialing Policy Development
• Internal File Audits
• Quality Improvement Metrics Analysis
• Survey Preparation
• Documentation Organization

Soft Skills

• Excellent Written Communication
• Excellent Verbal Communication

Certifications & Qualifications

• CPCS
• CPMSM

Industry Keywords

• CVO Operations
• NCQA Standards
• JCAHO
• CMS
• State Credentialing Requirements

Tools & Technologies

• CAQH
• VerityStream
• Cactus