Quality Supervisor (Healthcare Credentialing)

MED-METRIX INTERNATIONAL PH-I, INC.; Metro Manila; On-site; PHP 420,000 - 660,000; Full time

Job summary

MED-METRIX INTERNATIONAL PH-I, INC. is seeking a Quality Supervisor (Healthcare Credentialing) to ensure accuracy, completeness, and regulatory compliance of credentialing and enrollment processes in Metro Manila.

The role conducts audits, validates documentation, coordinates with internal teams and external partners, and upholds HIPAA and PHI safeguards while driving continuous quality improvements. The position requires applying audit methodologies, maintaining audit tools, and communicating

Qualifications

• Completed at least 2nd year in college or has a bachelor's degree in any related field.
• At least 2 years of experience as a Quality Supervisor in a Healthcare account.
• At least 2 years healthcare credentialing experience.
• Ability to interpret policies, procedures, and payer/agency requirements and apply them consistently.
• Ability to learn credentialing/enrollment systems.
• Demonstrated discretion and ability to maintain confidentiality of sensitive information.
• Ability to apply audit methodology, document findings clearly, and communicate issues with diplomacy and precision.
• Proficiency in Microsoft Office Suite.
• Strong interpersonal skills and ability to communicate well at all levels of the organization.
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses.
• High level of integrity and dependability with a strong sense of urgency and results oriented.
• Excellent written and verbal communication skills required.

Responsibilities

• Performs routine and targeted audits of credentialing and enrollment work products
• Supports external audits by compiling documentation and responding to information requests
• Validates documentation and data integrity, identifies compliance gaps, and supports corrective actions to strengthen quality, standardization, and audit readiness
• Audits delegated credentialing-related work products (e.g., roster files and supporting documentation) to ensure accuracy and completeness prior to submission
• The position is responsible compiling and reviewing policies and procedures. Ensuring an up-to-date copy is on file
• Tracks corrective actions from payers, verifies completion, and performs re-audits as needed to confirm sustained compliance
• Maintains audit tools (checklists, sampling logs, scorecards) and produces periodic audit reports and trend summaries
• Documents audit findings, assigns issue categories, and communicates results to operational teams and leadership
• Partners with credentialing and enrollment staff to provide feedback.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Always Understand and comply with Information Security and HIPAA policies and procedures
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Skills

Auditing

Data privacy

HIPAA compliance

Communication

Problem solving

Attention to detail

Information security

Education

Bachelor's degree or higher

Tools

Microsoft Office Suite

Job description

Job Purpose

The Quality Supervisor (Healthcare Credentialing) is responsible for ensuring the accuracy, completeness, and regulatory compliance of credentialing and enrollment processes. The Quality Supervisor (Healthcare Credentialing) conducts audits, validates documentation, and identifies compliance risks while supporting corrective actions and audit readiness. The Quality Supervisor (Healthcare Credentialing) collaborates with operational teams, delegated contracted insurance partners, and external stakeholders to enhance quality standards, uphold policy adherence, and ensure all activities align with regulatory and organizational requirements.

Duties & Responsibilities

• Performs routine and targeted audits of credentialing and enrollment work products


• Supports external audits by compiling documentation and responding to information requests


• Validates documentation and data integrity, identifies compliance gaps, and supports corrective actions to strengthen quality, standardization, and audit readiness


• Audits delegated credentialing-related work products (e.g., roster files and supporting documentation) to ensure accuracy and completeness prior to submission


• The position is responsible compiling and reviewing policies and procedures. Ensuring an up-to-date copy is on file


• Tracks corrective actions from payers, verifies completion, and performs re-audits as needed to confirm sustained compliance


• Maintains audit tools (checklists, sampling logs, scorecards) and produces periodic audit reports and trend summaries


• Documents audit findings, assigns issue categories, and communicates results to operational teams and leadership


• Partners with credentialing and enrollment staff to provide feedback.


• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards


• Always Understand and comply with Information Security and HIPAA policies and procedures


• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Qualifications

• Completed at least 2nd year in college or has a bachelor's degree in any related field


• Must have at least 2 years of experience as a Quality Supervisor in a Healthcare account


• Must have at least 2 years’ experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care or regulatory environment, or equivalent combination of relevant education and experience.


• Must have at least 2 years of healthcare credentialing experience


• Ability to interpret policies, procedures, and payer/agency requirements and apply them consistently


• Ability to learn credentialing/enrollment systems


• Demonstrated discretion and ability to maintain confidentiality of sensitive information


• Ability to apply audit methodology, document findings clearly, and communicate issues with diplomacy and precision


• Proficiency in Microsoft Office Suite


• Strong interpersonal skills, ability to communicate well at all levels of the organization


• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses


• High level of integrity and dependability with a strong sense of urgency and results oriented


• Excellent written and verbal communication skills required

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.


• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.


• Work Environment: The noise level in the work environment is usually minimal.