Provider Credentialing/Recredentialing Associates (Fixed Term Contract)

UST; Philippines; On-site; PHP 3,701,000 - 4,935,000; Full time

Job summary

UST is seeking a US Healthcare Provider Recredentialing Specialist to oversee the end-to-end recredentialing lifecycle for healthcare providers, ensuring payer, regulatory, and accreditation compliance.

The role emphasizes periodic credential validation, documentation updates, and ongoing monitoring to maintain an accurate provider network and audit readiness.

Qualifications

• US healthcare credentialing knowledge and processes.
• Strong attention to detail and documentation accuracy.
• Ability to manage high-volume credentialing workflows and meet SLAs.
• Fixed-term employment for 3 months.

Responsibilities

• Manage end-to-end provider recredentialing in line with timelines.
• Collect and review recredentialing applications via CAQH or internal systems.
• Perform primary source verification for licensure, board certs, education, and work history.
• Check data against State Boards, NPPES, OIG, NPDB, etc.
• Conduct sanction and exclusion checks (OIG/NPDB/Medicare).
• Validate provider profiles and audit credentialing files for readiness.
• Coordinate with providers, QA, compliance, and operations; escalate as needed.
• Update dashboards and trackers; highlight risks and delays.

Skills

US healthcare experience

Detail-oriented

Analytical mindset

Strong communication

High-volume operations

3 months fixed term employment

Tools

Microsoft Excel

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

Provider Credentialing, NPPES, NPDB, Microsoft Excel