Provider Credentialing & Enrollment – Medallion/CredentialStream Experience

Access Healthcare Services Manila, Inc.; Taguig; On-site; PHP 240,000 - 420,000; Full time

Job summary

Access Healthcare Services Manila, Inc. is seeking a Provider Enrollment and Credentialing specialist to join our growing team in Taguig.

The role focuses on enrolling healthcare providers into insurance networks and ensuring credentials meet industry standards for US providers, supporting regulatory and payer requirements. Responsibilities include completing enrollment activities, CAQH, payer portals, and credentialing follow-ups.

Qualifications

• Experience in Provider Enrollment and Credentialing for US healthcare customers.
• Experience with Medallion and CredentialStream.
• Solid knowledge of payer processes and credentialing.
• Experience in a medical billing company and with billing software is advantageous.
• Willingness to work on-site at McKinley, Taguig.

Responsibilities

• Manage enrollment activities including CAQH, payer portals, and enrollment documents.
• Perform credentialing reviews, documentation, and payer follow-ups.
• Continue enrollment and credentialing activities after clearance for clients.
• Assist clients in enrolling physician groups with specified payers.
• Ensure payers receive all required information to complete enrollment.

Skills

Provider Enrollment

Credentialing

Payer processes

Medical billing software

On-site work

Tools

Medallion

CredentialStream

Medical billing software

Job description

Access Healthcare is currently looking for Provider Enrollment and Credentialing specialist to be part of our growing team.

The Provider Enrollment and Credentialing Specialist is responsible for managing the process of enrolling healthcare providers into insurance networks and ensuring that their credentials meet industry standards. This role ensures that healthcare professionals are properly credentialed to provide services, meet regulatory and payer requirements, and support operational efficiency within a healthcare organization.

Responsibilities

• Completion of Enrollment Activities (including, but not limited to, online applications, roster completion, CAQH, PDF applications needed to enroll a provider (physician group) with a payer), provided all information for enrollment to take place (including, but not limited to, access to a payer portal, access to Availity, and CAQH user name and passwords, in addition to all information needed to enroll, including signature pages).
• Provider credentialing services shall also include review, documentation and follow-up with payers.
• Once cleared, you will continue to perform Credentialing Activities – Completion of Enrollment Activities to Client as stated above.
• Credentialing Specialist shall assist Client in enrolling the providers (physician groups) with the specified payers.
• Credentialing services shall also include review, documentation and follow-up with payers until the providers are enrolled with the payers.

Qualifications

• Must have experience in Provider Enrollment and Credentialing processes for US healthcare customers.
• Must have experience in Medallion and CredentialStream
• Strong knowledge of Payer Processes and Credentialing
• Prior experience of working in a medical billing company and use of medical billing software is a definite advantage.
• Must be amenable to work onsite at McKinley, Taguig.