Provider Data Integrity & Credentialing Specialist

UST USource; Pateros; On-site; PHP 500,000 - 750,000; Full time

Job summary

UST USource is seeking a Provider Data Management Analyst to review, validate, and maintain accurate provider information within our BPM environment in Manila. You will support outreach verification, returned mail handling, credentialing record updates, and PIMS claim-related setup, while meeting quality, productivity, and SLA targets.

The successful candidate will have a bachelor’s degree and at least three years of US healthcare provider data management experience, with strong documentation

Qualifications

• Knowledge of US healthcare payer provider data management, credentialing, or provider operations.
• Understanding of provider demographics, specialties, affiliations, practice locations, NPI information, and credential records.
• Familiarity with CAQH, NPPES, state licensing sources, OIG, and NPDB, as applicable.
• High attention to detail and strong documentation accuracy.
• Effective provider outreach, analytical, problem-solving, and escalation skills.
• Ability to work within high-volume queues and SLA-driven BPM operations.
• Understanding of BPM processes, workflow adherence, quality standards, and productivity metrics.

Responsibilities

• Review and update provider demographics, addresses, specialties, affiliations, practice locations, and related provider records.
• Validate and update provider information according to approved BPM workflows and procedures.
• Retain provider correspondence, notes, records, and supporting evidence.
• Identify incomplete or conflicting information and follow escalation procedures.
• Support outreach verification and returned mail processes with proper documentation.
• Review credentialing records and support recredentialing activities and compliance checks.
• Research and load missing provider data into claims systems to enable downstream processing.
• Update trackers, dashboards, and status records; support quality and SLA reporting.

Education

Bachelor's degree

3+ years experience in US healthcare provider data management

Job description

UST USource is seeking a Provider Data Management Analyst to review, validate, and maintain accurate provider information within our BPM environment in Manila. You will support outreach verification, returned mail handling, credentialing record updates, and PIMS claim-related setup, while meeting quality, productivity, and SLA targets.

The successful candidate will have a bachelor’s degree and at least three years of US healthcare provider data management experience, with strong documentation