Provider Credentialing/Recredentialing Associates

UST; Philippines; On-site; PHP 446,000 - 781,000; Full time

Job summary

UST in the Philippines seeks a US Healthcare Provider Recredentialing Specialist to manage end-to-end recredentialing of providers, ensuring payer, regulatory, and accreditation compliance.

You will handle PSV, data validation, document review, and SLA-driven processing for high-volume cases, coordinating with internal teams and external verification agencies.

This 3-month fixed-term role emphasizes accuracy, timely updates, and audit readiness in a fast-paced environment.

Qualifications

• The candidate must have experience in US healthcare credentialing or related processes.
• Strong attention to detail and accurate documentation are essential.
• Demonstrated analytical and problem-solving skills to manage complex credentialing data.

Responsibilities

• Manage end-to-end provider recredentialing lifecycle.
• Ensure compliance with payer, regulatory, and accreditation requirements.
• Perform primary source verification (PSV) for licensure, board certification, education, and work history.
• Validate data from authoritative sources (State Boards, NPPES, OIG, NPDB).
• Conduct sanctions and exclusion checks (OIG, NPDB, Medicare/Medicaid).
• Maintain provider data accuracy and support audit readiness.
• Coordinate with providers, QA, compliance, and operations teams.
• Update dashboards and trackers for recredentialing status.

Skills

US healthcare experience

Attention to detail

Analytical thinking

Communication

High-volume processing

3 months fixed term

Job description

Role Description

The US Healthcare Provider Recredentialing Specialist is responsible for managing the end-to-end recredentialing lifecycle for healthcare providers to ensure compliance with payer, regulatory, and accreditation requirements. The role focuses on periodic validation of provider credentials, documentation updates, and ongoing monitoring to maintain an accurate and compliant provider network.

Role Description

The US Healthcare Provider Recredentialing Specialist is responsible for managing the end-to-end recredentialing lifecycle for healthcare providers to ensure compliance with payer, regulatory, and accreditation requirements. The role focuses on periodic validation of provider credentials, documentation updates, and ongoing monitoring to maintain an accurate and compliant provider network.

Recredentialing is a cyclical process that ensures providers continue to meet required standards through updated verification and monitoring activities.

Key Responsibilities

• Recredentialing Lifecycle Management
• Manage end-to-end provider recredentialing processes in line with payer and regulatory timelines
• Initiate recredentialing cases based on due dates, expirable, and renewal triggers
• Track and manage provider credential expirations (licenses, certifications, malpractice insurance)
• Documentation & Application Review
• Collect and review recredentialing applications via systems like CAQH or internal platforms
• Validate completeness and accuracy of provider documentation
• Follow up with providers for missing or inconsistent information
• Primary Source Verification (PSV)
• Perform PSV for:
  • Licensure
  • Board certification
  • Education & training
  • Work history
• Validate data from authoritative sources (State Boards, NPPES, OIG, NPDB, etc.)
• Ensure compliance with regulatory and payer requirements
• Background & Compliance Checks
• Conduct sanction and exclusion checks (OIG, NPDB, Medicare/Medicaid)
• Identify discrepancies, red flags, or compliance risks
• Escalate issues for further clinical or committee review
• Provider Data Validation & Quality Checks
• Ensure accuracy of provider profile (specialty, affiliations, demographics, practice locations)
• Perform quality audits on completed credentialing files
• Maintain documentation integrity for audit readiness
• Workflow Management & Productivity
• Manage assigned inventory/queue ensuring SLA/TAT adherence
• Maintain productivity and quality benchmarks (first-time-right processing)
• Support backlog clearance and aging reduction initiatives
• Stakeholder Coordination
• Interact with providers, internal teams, and external verification agencies
• Support escalations and provide status updates to clients/stakeholders
• Collaborate with QA, compliance, and operations teams
• Reporting & Governance
• Update dashboards and trackers for recredentialing status and closures
• Highlight risks related to expirable, delays, or compliance gaps
• Support audit readiness and regulatory reviews

Skills & Competencies

• US healthcare experience
• High attention to detail and documentation accuracy
• Analytical & problem-solving mindset
• Strong communication (provider outreach, escalations)
• Ability to work with high-volume operations and meet SLAs
• Amenable to 3 months fixed term employment

Skills US Healthcare, Provider Credentialing, NPDB, NPPES, Healthcare Systems