Credentialing Specialist

Connext; Davao Region; On-site; PHP 360,000 - 540,000; Full time

Job summary

Connext is seeking a Credentialing Specialist to manage end-to-end provider credentialing, re-credentialing, and privileging for physicians, APPs, and clinical staff. You will coordinate enrollments with commercial payers, Medicare, Medicaid, hospitals, and facilities, and maintain accurate credentialing records.

The role requires attention to detail, strong organizational skills, and the ability to work independently, with clear English communication across internal teams and external providers.

Qualifications

• Knowledge of credentialing, re-credentialing and privileging processes (PSV, NPDB, CAQH, PECOS, NPPES).
• Strong documentation accuracy and attention to detail.
• Ability to organize and prioritize multiple priorities and deadlines.
• Experience researching and analyzing data relevant to credentialing.
• Ability to work independently with minimal supervision.

Responsibilities

• Manage the complete credentialing, re-credentialing and privileging lifecycle for providers.
• Process provider enrollments with commercial payers, Medicare, Medicaid, hospitals and facilities.
• Maintain credentialing files and documentation for regulatory compliance.
• Perform PSV and monitor provider eligibility through NPDB, OIG, state boards, and other sources.
• Maintain provider profiles in CAQH, PECOS, NPPES, CMS and other platforms.
• Process provider license renewals including professional licenses, DEA registrations, and CS registrations.
• Complete payer revalidation requests and credentialing applications.
• Collaborate with billing teams to resolve credentialing-related denials and authorizations issues.
• Maintain audit-ready documentation and support audits.
• Prepare credentialing reports and documentation for leadership and committees.

Skills

Credentialing knowledge

Attention to detail

Organization

Research & data analysis

Independent work

English communication

Education

Bachelor's Degree in Healthcare Administration / related field

Tools

Microsoft Office (Word, Excel)

Job description

The Credentialing Specialist is responsible for independently managing the end-to-end provider credentialing, re-credentialing, and privileging process for physicians, advanced practice providers, and clinical staff. This role ensures providers maintain active enrollment with commercial payers, Medicare, Medicaid, hospitals, and healthcare facilities while maintaining accurate provider records across credentialing systems.

Job Description

• Manage the complete credentialing, re-credentialing, and privileging lifecycle for healthcare providers.
• Process provider enrollments with commercial insurance payers, Medicare, Medicaid, hospitals, and healthcare facilities.
• Maintain provider records, credentialing files, and documentation required for regulatory compliance.
• Perform Primary Source Verification (PSV) and monitor provider eligibility through NPDB, OIG/GSA-SAM, state licensing boards, and other verification sources.
• Maintain provider profiles within CAQH, PECOS, NPPES, CMS, and other credentialing platforms.
• Process provider license renewals including professional licenses, DEA registrations, and Controlled Substance registrations.
• Complete payer revalidation requests and credentialing applications.
• Partner with billing teams to resolve credentialing-related claim denials and authorization issues.
• Maintain audit-ready documentation and support internal and external compliance audits.
• Prepare credentialing reports and provider documentation for leadership and credentialing committees.

Qualifications

• Demonstrates knowledge and understanding of the credentialing, re-credentialing, and privileging processes (PSV, NPDB, CAQH, PECOS, NPPES, payer enrollment).
• Demonstrates strong attention to detail and documentation accuracy.
• Proven ability to organize and prioritize work and manage multiple priorities and deadlines independently.
• Proven ability to research and analyze data.
• Proven ability to work independently with minimal supervision.
• Proven ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Clear and coherent both written and verbal communication skills in English.

Screening Criteria

• Bachelor's Degree in Healthcare Administration, Nursing, Medical Technology, Public Health, Health Services, or a related healthcare field.
• Minimum of three (3) years of healthcare provider credentialing experience.
• Experience in Microsoft Office applications (Word, Excel) and internet resources.