Senior Credentialing Specialist – End to End

MCVO Talent Outsourcing Services; Manila; On-site; PHP 600,000 - 800,000; Full time

Job summary

MCVO Talent Outsourcing Services in Manila seeks a Senior Credentialing Specialist – End to End to oversee provider enrollment and re-credentialing with insurance networks, clearinghouses, and credentialing bodies. This role requires strong organization and leadership to guide a small team and ensure timely submissions.

You will manage primary source verifications, maintain compliant records, coordinate with payers and providers, and prepare reports for management.

Qualifications

• College or equivalent required; an Associate’s degree in healthcare administration or a related field is preferred.
• More than 5 years experience in healthcare credentialing.
• End-to-end knowledge of provider and facility enrollment processes and regulatory requirements.
• Experience managing full enrollment and revalidation for Medicare, Medicaid, and commercial payers.
• Skilled with payer portals and credentialing systems (PECOS, CAQH) and credentialing software; proficient in Microsoft Office.

Responsibilities

• Preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.
• Ensure accuracy and completeness of credentialing documentation (licenses, certifications, insurance).
• Monitor credentialing timelines and ensure compliance with deadlines and payer requirements.
• Perform primary source verifications and maintain credentialing records with accurate data entry.
• Assist in audits to verify HIPAA and regulatory compliance.
• Liaise with providers and external entities to resolve credentialing issues and follow up with payers and clearinghouses.

Job description

Senior Credentialing Specialist – End to End

Purpose – The Senior Credentialing Specialist supports the accurate and timely credentialing and re-credentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves ability in handling a team, maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.

Key Responsibilities

Credentialing and Recredentialing Support:

• 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:

• Liaise with 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:

• Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.
• Train new team members on credentialing processes and software.

Key Qualifications:

• College or equivalent required; an Associate’s degree in healthcare administration or a related field is preferred.
• More than 5 years experience in healthcare credentialing
• Comprehensive, end-to-end knowledge of provider and facility enrollment processes, as well as current healthcare regulations.
• Proven experience managing full enrollment and revalidation for Medicare, Medicaid, and commercial insurance payers.
• Skilled in utilizing major payer portals and credentialing systems, including PECOS, CAQH, and various insurance carrier platforms.
• Proficient in specialized credentialing software and the Microsoft Office Suite (Word, Excel, Outlook).
• Ability to manage multiple payer enrollments, follow-ups, application submissions, and provider records independently.
• Excellent verbal and written communication skills, with a track record of collaborating effectively across internal teams and external departments.
• Organized with strong attention to detail and the ability to prioritize tasks in a fast‑paced environment.

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.