Senior Credentialing Specialist – End to End

MCVO Talent Outsourcing Services; Philippines; On-site; PHP 500,000 - 900,000; Full time

Job summary

MCVO Talent Outsourcing Services seeks a Senior Credentialing Specialist to ensure accurate credentialing and re-credentialing of healthcare providers across networks, with emphasis on compliance and timely documentation.

You will lead credentialing processes, coordinate with providers, payers, and clearinghouses, and train new staff while maintaining meticulous records in credentialing software and Microsoft Office tools.

Qualifications

• 5+ years of experience in healthcare credentialing.
• End-to-end knowledge of provider and facility enrollment and regulations.
• Experience managing Medicare, Medicaid, and commercial payers enrollment.
• Proficient with PECOS, CAQH and payer portals.

Responsibilities

• Prepare, submit, and track provider enrollment applications for payers.
• Perform primary source verifications and maintain credentialing records.
• Liaise with providers, payers, and clearinghouses to resolve issues.
• Train new team members on credentialing processes.

Skills

Healthcare credentialing

Communication skills

Organization/detail orientation

Multitasking

Team collaboration

Education

Associate’s degree in healthcare administration

Tools

PECOS

CAQH

Insurance carrier platforms

Microsoft Office

Job description

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.