Senior Credentialing Specialist

MCVO Talent Outsourcing Services; Makati; On-site; PHP 420,000 - 540,000; Full time

Job summary

A leading outsourcing service provider is seeking a Senior Credentialing Specialist to assist in the credentialing and recredentialing of healthcare providers. This role involves ensuring compliance, tracking documentation, and acting as a liaison between providers and external entities. Candidates should have strong organizational skills, experience in administrative tasks within the healthcare sector, and proficiency in relevant software. This position may require flexibility and can be performed remotely or in-office, depending on organizational needs.

Qualifications

• At least 1-3 years of administrative experience, preferably in healthcare or credentialing.
• Basic knowledge of credentialing processes and healthcare regulations.
• Familiarity with credentialing software and US payer processes is an advantage.
• Excellent verbal and written communication skills for interacting with internal and external departments.
• Ability to multitask and work collaboratively in a fast-paced environment.

Responsibilities

• Assist in preparing, submitting, and tracking provider enrollment applications.
• Ensure accuracy and completeness of credentialing documentation.
• Act as a liaison to resolve credentialing-related issues.
• Perform primary source verifications and maintain compliant credentialing records.
• Act as liaison between providers, payers, and external entities to resolve issues.
• Provide support during high-volume credentialing periods and prepare reports.

Skills

Organizational skills

Attention to detail

Communication skills

Proficiency in Microsoft Office Suite

Verbal and written communication

Organizational skills

Team collaboration

Office software

Education

Associate’s degree in healthcare administration or a related field

Tools

Credentialing software

Microsoft Office

Job description

About the job Senior Credentialing Specialist

Job Description:

Purpose

The Junior to Mid Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves assisting the Senior Credentialing Specialist in maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.

Key Responsibilities

Credentialing and Recredentialing Support

Assist the Senior Credentialing Specialist in preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.

Ensure the accuracy and completeness of provider credentialing documentation, including licenses, certifications, and insurance coverage.

Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.

Compliance and Documentation

Perform primary source verifications as directed, maintaining adherence to regulatory and organizational standards.

Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.

Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.

Communication and Coordination

Act as a liaison between the Senior Credentialing Specialist, healthcare providers, and external entities to resolve credentialing-related issues.

Follow up with providers, payers, and clearinghouses to gather required information or clarify discrepancies.

Communicate updates on credentialing processes and progress to the Senior Credentialing Specialist and management.

Administrative Support

Provide support during high-volume credentialing periods, including managing overflow tasks as assigned by the Senior Credentialing Specialist.

Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.

Assist in training new team members on credentialing processes and software.

Required Knowledge and Skills

Basic knowledge of credentialing processes and healthcare regulations.

Strong organizational skills with exceptional attention to detail and accuracy.

Proficiency in credentialing software and Microsoft Office Suite (Word, Excel, Outlook).

Excellent verbal and written communication skills for interacting with internal and external departments.

Ability to multitask and work collaboratively in a fast-paced environment.

Additional Requirements

Education

College or equivalent required; an Associate’s degree in healthcare administration or a related field is preferred.

Experience

• At least 1-3 years of administrative experience, preferably in healthcare or credentialing.
• Familiarity with credentialing software and US payer processes is an advantage.

Attributes

Proactive, team-oriented, and capable of handling sensitive information professionally.

Office-based or remote, depending on organizational needs.

May require flexibility during high-demand periods to meet deadlines.

Shift / Hours

Monday Friday in one single shift, 9:00 AM EST - 6:00 PM EST. Note this is +12 or +13 Philippine time, which will be 9:00 PM PHT 6:00 AM in PHT.