Credentialing Manager (Hybrid Setup)

CF Solutions Philippines Inc.; Quezon City; On-site; PHP 900,000 - 1,800,000; Full time

Job summary

CF Solutions Philippines Inc. is seeking an experienced Credentialing Manager to lead credentialing and provider enrollment for our healthcare clients in the Philippines.

You will manage end-to-end credentialing, recredentialing, and payer enrollment, ensuring timely, accurate files and regulatory compliance. You will mentor the credentialing team, monitor KPIs, collaborate with payers and providers, and implement policies to improve efficiency and accuracy across NCQA, CMS, and Joint Commission

Qualifications

• Bachelor's degree in Healthcare Administration or related field.
• Minimum of 5 years of healthcare credentialing experience, including 2 years in a leadership or management role.
• Strong knowledge of provider credentialing, payer enrollment, recredentialing, and provider data management.
• Familiarity with Medicare, Medicaid, CAQH, PECOS, NPPES, and commercial payer requirements.

Responsibilities

• Manage the end-to-end credentialing and recredentialing process for healthcare providers.
• Oversee provider enrollment and maintenance with commercial insurance payers, Medicare, Medicaid, and other healthcare networks.
• Lead, train, and mentor the credentialing team to ensure productivity and quality standards are met.
• Monitor credentialing statuses, expirations, and renewals to maintain provider compliance.
• Develop and implement credentialing policies, procedures, and best practices.
• Serve as the primary point of contact for credentialing-related escalations and client concerns.
• Conduct quality audits to ensure accuracy, completeness, and compliance of credentialing files.
• Generate and analyze credentialing reports, KPIs, and operational metrics.
• Collaborate with clients, healthcare providers, insurance payers, and internal stakeholders to resolve credentialing issues.
• Ensure compliance with NCQA, CMS, Joint Commission, and other applicable regulatory standards.
• Identify process improvement opportunities to enhance efficiency and turnaround times.

Skills

Leadership

Team management

Communication

Problem-solving

Analytical thinking

Education

Bachelor's degree in Healthcare Administration

Leadership experience in healthcare credentialing (2+ yrs)

Tools

Microsoft Excel

Job description

We are seeking an experienced Credentialing Manager to lead and oversee the credentialing and provider enrollment operations for our healthcare clients. The ideal candidate will have strong knowledge of healthcare credentialing processes, payer enrollment requirements, and team management. This role is responsible for ensuring timely and accurate credentialing, recredentialing, provider enrollment, and compliance with regulatory and payer standards.

Key Responsibilities

• Manage the end-to-end credentialing and recredentialing process for healthcare providers.

• Oversee provider enrollment and maintenance with commercial insurance payers, Medicare, Medicaid, and other healthcare networks.

• Lead, train, and mentor the credentialing team to ensure productivity and quality standards are met.

• Monitor credentialing statuses, expirations, and renewals to maintain provider compliance.

• Develop and implement credentialing policies, procedures, and best practices.

• Serve as the primary point of contact for credentialing-related escalations and client concerns.

• Conduct quality audits to ensure accuracy, completeness, and compliance of credentialing files.

• Generate and analyze credentialing reports, KPIs, and operational metrics.

• Collaborate with clients, healthcare providers, insurance payers, and internal stakeholders to resolve credentialing issues.

• Ensure compliance with NCQA, CMS, Joint Commission, and other applicable regulatory standards.

• Identify process improvement opportunities to enhance efficiency and turnaround times.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.

• Minimum of 5 years of healthcare credentialing experience, including 2 years in a leadership or management role.

• Strong experience with provider credentialing, payer enrollment, recredentialing, and provider data management.

• Familiarity with Medicare, Medicaid, CAQH, PECOS, NPPES, and commercial insurance payer requirements.

• Proven experience managing teams and driving operational performance.

• Excellent organizational, analytical, and problem-solving skills.

• Strong communication and stakeholder management abilities.

• Proficient in Microsoft Office applications, particularly Excel.

• Experience working with US healthcare providers and medical practices is highly preferred.