Credentialing Compliance Analyst

Hammerjack Pty Ltd; Philippines; Hybrid; PHP 500,000 - 900,000; Full time

Job summary

Hammerjack Pty Ltd in the Philippines seeks a Credentialing Compliance Analyst to review managed care contracts, verify provider data, and ensure regulatory adherence. You will support payer relations, enrollment processes, and contract management across internal teams and external partners.

The role requires strong analytical skills, experience in US healthcare, and proficiency with MS Office. Hybrid work setup and night shift schedule are offered in a mission-driven environment.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Information Systems, or related field.
• Experience in US healthcare, preferably supporting managed care, provider operations, payer relations, revenue cycle.
• Experience in provider credentialing and enrollment processes, including verification of provider information.
• Working knowledge of managed care contracts, reimbursement methodologies, payer policies, and claims processes.
• Familiarity with credentialing, provider data management, contract management, and healthcare information systems.
• Strong analytical and problem-solving skills with the ability to interpret complex healthcare contracts.

Responsibilities

• Review and maintain managed care contracts to ensure compliance with standards and regulations.
• Serve as a resource for contract terms, payer policies, and reimbursement methodologies.
• Maintain contract repositories, fee schedules, and payer policy inventories.
• Analyze contract language and payer communications for business impact.
• Research and resolve payer-related issues, disputes, and claims inquiries.
• Coordinate with stakeholders to support contract implementation and compliance monitoring.
• Prepare reports and analyses regarding managed care agreements and payer performance.
• Identify opportunities to improve contract management efficiency and standardization.

Skills

US healthcare

Credentialing & enrollment

Payer policies

Analytical skills

Stakeholder mgmt

Provider data mgmt

Contract mgmt

Education

Bachelor's degree in related field

Tools

Microsoft Office

Job description

• Be part of a growing shared services company in a non profit health care company


• Opportunity to gain pioneering experience in a hybrid work setup

About Our Client

Our client is a leading organization in the U.S. health and safety sector, recognized for its focus on innovation, high-quality patient care, and operational excellence. Its expanding global capability center in Taguig, Philippines offers a stable and mission-driven work environment, multinational collaboration, and strong prospects for long-term career advancement.

Job Description

Key Responsibilities of the Credentialing Compliance Analyst:

• Review and maintain managed care contracts to ensure compliance with organizational standards, regulatory requirements, and approved contract language.


• Serve as a subject matter resource for contract terms, payer policies, reimbursement methodologies, and managed care regulations.


• Maintain accurate contract repositories, fee schedules, and payer policy inventories to support operational consistency and reporting needs.


• Analyze contract language, policy updates, and payer communications to assess business and financial impact.


• Research, document, and resolve payer-related issues, disputes, claims inquiries, and reimbursement concerns.


• Coordinate with internal stakeholders to support contract implementation, compliance monitoring, and operational readiness.


• Prepare reports, summaries, and executive-level analyses regarding managed care agreements and payer performance.


• Identify and implement process improvement opportunities that enhance contract management efficiency, accuracy, and standardization.

The Successful Applicant

Successful Candidate Profile - Credentialing Compliance Analyst

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Information Systems, or a related field.


• Proven experience within the US healthcare industry, preferably supporting managed care, provider operations, payer relations, healthcare administration, or revenue cycle functions.


• Experience in provider credentialing and enrollment processes, including coordination with health plans, verification of provider information, and maintenance of provider records.


• Working knowledge of managed care contracts, reimbursement methodologies, payer policies, healthcare regulations, and claims processes.


• Familiarity with credentialing, provider data management, contract management, and healthcare information systems.


• Strong analytical and problem-solving skills with the ability to interpret complex healthcare contracts and payer requirements.


• Advanced proficiency in Microsoft Office applications, particularly Excel, Word, PowerPoint, and Outlook.


• Excellent stakeholder management and communication skills with the ability to collaborate across multiple departments and external healthcare partners.

What's on Offer

Join a respected organization in the health and safety industry where your work helps ensure quality care and regulatory compliance. This role offers a hybrid work setup, a night shift schedule, and a competitive compensation package. You'll be part of a team focused on maintaining high standards in provider credentialing and operational excellence.

Contact

Juan Dela Cruz

Quote job ref

JN-102026-7119301

Phone number

[phone]