Credentialing Specialist

AGSI; Philippines; On-site; PHP 300,000 - 460,000; Full time

Job summary

AGSI in the Philippines seeks a Credentialer to manage credentialing, recredentialing, and insurance enrollment for healthcare providers, ensuring timely submissions and payer compliance.

You will coordinate with providers, insurers, and internal teams; verify licenses, NPI, CAQH, and other documents; and maintain up-to-date credentialing records.

The role requires attention to detail, strong follow-up, and clear communication, plus the ability to handle multiple providers and deadlines.

Qualifications

• Experience in healthcare credentialing, provider enrollment, medical billing, or healthcare administration.
• Familiarity with CAQH, NPI, PECOS, Medicare, Medicaid, and commercial payers.
• Strong attention to detail and documentation skills.

Responsibilities

• Manage credentialing, recredentialing, and enrollment with commercial and government payers.
• Collect, verify, and maintain provider credentials (licenses, certifications, NPI, CAQH, malpractice).
• Complete and submit insurance enrollment and credentialing applications on time.
• Monitor application status, follow up with payers, resolve missing information.
• Communicate with providers and internal teams about requirements and status.
• Maintain accurate credentialing records and track expirations.
• Coordinate with insurance representatives and payer portals for updates.
• Ensure compliance with payer, regulatory, and organizational requirements.
• Prepare reports on credentialing status, expirations, and outstanding items.
• Handle calls and email correspondence with providers, payers, and stakeholders.

Skills

Healthcare credentialing

Provider enrollment

Medical billing

Healthcare administration

CAQH familiarity

NPI familiarity

PECOS familiarity

Medicare/Medicaid knowledge

Strong communication

Tools

CAQH portal

Payer portals

NPI registry

Job description

Job Description

Job Summary

The Credentialer is responsible for managing the credentialing, recredentialing, and insurance enrollment process for healthcare providers. This role involves coordinating with providers, insurance companies, and other stakeholders to ensure accurate documentation, timely submissions, and compliance with payer requirements.

Key Responsibilities

• Manage initial credentialing, recredentialing, and provider enrollment with commercial and government insurance payers.
• Collect, verify, and maintain provider credentials, including licenses, certifications, NPI, CAQH, malpractice insurance, and other required documents.
• Complete and submit insurance enrollment and credentialing applications accurately and within required timelines.
• Monitor application status, follow up with insurance payers, and resolve missing information or enrollment issues.
• Communicate with providers and internal teams regarding credentialing requirements, documentation, and application status.
• Maintain accurate and up-to-date provider credentialing records and track expiration dates.
• Coordinate with insurance representatives and payer portals to obtain updates, approvals, and participation information.
• Ensure compliance with payer, regulatory, and organizational credentialing requirements.
• Prepare regular reports on credentialing status, pending applications, expirations, and outstanding requirements.
• Handle calls and email correspondence with providers, insurance companies, and other stakeholders as needed.

Preferred Qualifications

• Experience in healthcare credentialing, provider enrollment, medical billing, or healthcare administration.
• Familiarity with CAQH, NPI, PECOS, Medicare, Medicaid, and commercial insurance payers.
• Strong attention to detail and documentation skills.
• Excellent follow-up, organization, and communication skills.
• Comfortable making phone calls and coordinating with insurance representatives.
• Ability to manage multiple providers, applications, and deadlines simultaneously.