Provider Credentialing & Contracting Specialist

Neolytix; Philippines; On-site; PHP 3,450,000 - 5,332,000; Full time

Job summary

Neolytix in the Philippines is seeking a Credentialing/ Insurance Contracting Specialist to manage provider credentialing and contracting with US payers, including government programs.

You will maintain and audit provider files, keep CAQH, PECOS, NPPES up to date, handle revalidations, add new providers and groups, and coordinate with clients, doctors and billing staff to resolve issues.

Qualifications

• Experience with government and commercial payer credentialing in at least one US state.
• Minimum 1 year in submitting contracting and credentialing applications.
• Proficient with Excel, Word, and Internet.

Responsibilities

• Maintain individual provider files and group information for credentialing and contracting applications.
• Maintain internal trackers to ensure information accuracy and access.
• Update CAQH database files on schedule as published by CMS.
• Complete revalidation requests from government payers.
• Credential providers and groups to commercial payers, Medicare, and Medicaid.
• Perform re-credentialing for commercial payers.
• Coordinate with clients, doctors, and billing staff to resolve missing items or license expirations.
• Maintain provider profiles on CAQH, PECOS, NPPES, and CMS databases.
• O ther duties as assigned.

Skills

Provider credentialing

Contracting

CAQH

CMS databases

Excel

Detail oriented

Time management

Customer service

Tools

CAQH

PECOS

NPPES

CMS databases

Excel

Job description

Neolytix in the Philippines is seeking a Credentialing/ Insurance Contracting Specialist to manage provider credentialing and contracting with US payers, including government programs.

You will maintain and audit provider files, keep CAQH, PECOS, NPPES up to date, handle revalidations, add new providers and groups, and coordinate with clients, doctors and billing staff to resolve issues.