Credentialing & Contracting Manager

CF Outsourcing Solutions; Quezon City; On-site; PHP 1,000,000 - 2,000,000; Full time

Job summary

CF Outsourcing Solutions is seeking a Credentialing and Contracting Manager to oversee provider enrollment, network participation, and insurance contract negotiations. You will ensure accurate credentialing and enrollment with payers while optimizing reimbursement terms and maintaining regulatory compliance.

The role requires leadership across credentialing, enrollment operations, and payer relations, with strong focus on NCQA, URAC, and CMS standards to drive revenue cycle success.

Qualifications

• 5+ years of direct healthcare credentialing and insurance contracting experience.
• Progressive leadership or management oversight experience.
• Knowledge of NCQA, URAC, CMS standards and payer portals.

Responsibilities

• Provider Credentialing & Enrollment across networks.
• Oversee full lifecycle of credentialing, re-credentialing, and roster management.
• Maintain accuracy in CAQH Proview, PECOS, NPPES and Medicaid portals.
• Design systems for timely license, malpractice, DEA, and revalidation tracking.
• Review, redefine, and manage MCO contracts and fee schedules.
• Collaborate with billing and finance to audit enrollment denials.
• Build KPI tracking and write standard operating procedures.

Skills

Provider credentialing

Contracting negotiations

Leadership

Education

Bachelor’s degree in Healthcare Administration

Bachelor’s degree in Business Management

CPCS

CPMSM

Job description

Job Summary:

The Credentialing and Contracting Manager oversees the strategic and operationalexecution of provider enrollment, network participation, and insurance contractnegotiations. This leadership role ensures that all medical or behavioral healthprofessionals within the organization are accurately credentialed, enrolled with payers,and aligned with optimal reimbursement terms to drive revenue cycle success andmaintain regulatory compliance.

Key Responsibilities:

• Provider Credentialing & Enrollment
• Application Management: Oversee and direct the full lifecycle Of initial
• credentialing, re«edentialing, and provider roster management across commercial,
• Medicare, and Medicaid networks.
• Platform Governance: Maintain absolute accuracy in central identity databases
• including CAQH Proview, PECOS, NPPES (NP' registration), and specific state
• Medicaid portals.
• Expiry Tracking: Design and manage rigorous monitoring systems for the timely
• renewal of medical licenses, malpractice insurance policies, DEA certificates, and
• payer revalidation timdines to mitigate billing conWiance risks.
• 2. Payer Contracting & Rate Negotiation
• Contract Management: Review, redine, and manage managed care organization
• (MCO) contracts, single-case agreements, and fee schedule amendments.
• Financial Analysis: Partner with corporate leadership to analyze reimbursement
• rate Structures, evaluating financial impacts against local market benchmarks
• payer Rdations: Build and sustain strategic relationships with payer network
• managers to expedite enrollment workflows and resolve structural claims issues.
• 3. Compliance & Cross-Functional Operations
• Regulatory Standards: Guarantee Organizational readiness and compliance wid.
• NCQA, URAC, CMS, and local state department Of health requirements.
• Revenue Alignment: Collaborate closely with medical billing, coding, and
• finance teams to audit and resolve enrollment-related claims denials or holds.
• Process Optimization: Standardize workflow operations by building KPI trackingand writing standard operating procedures (Sops).

Qualifications:

• Education: Bachelors degree in Healthcare Administration, Business Management,
• or a strictly related field required.
• Experience: Minimum of æ5 years of direct healthcare credentialing and insurance
• contracting experience, demonstrating progressive leadership Or management
• oversight.
• Certifications: Certified provider Credentialing Specialist (CPCS) Or Certified
• Professional Medical Services Management (CPMSM) highly preferred.
• Skills: Advanced data parsing skills, profound familiarity with managed Care
• terminology, and strong negotiation capabilities