Credentialing Specialist

AMTEC GLOBAL SOLUTIONS INC; Philippines; On-site; PHP 360,000 - 540,000; Full time

Job summary

AMTEC GLOBAL SOLUTIONS INC is seeking a Credentialing Specialist to manage credentialing, recredentialing, and provider enrollment with commercial and government payers. You will collect, verify, and maintain provider credentials (licenses, certifications, NPI, CAQH, malpractice insurance) and submit enrollment applications on time.

You will monitor statuses, follow up with payers, and resolve missing information, while coordinating with providers and internal teams to ensure compliance and

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.

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.

Skills

Attention to detail

Documentation skills

Follow-up

Organization

Communication

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.