Strategic Credentialing & Contracting Leader

CF Outsourcing Solutions; Quezon City; On-site; PHP 1,000,000 - 2,000,000; Full time

Job summary

CF Outsourcing Solutions is seeking a Credentialing and Contracting Manager to oversee provider enrollment, network participation, and insurance contract negotiations. You will ensure accurate credentialing and enrollment with payers while optimizing reimbursement terms and maintaining regulatory compliance.

The role requires leadership across credentialing, enrollment operations, and payer relations, with strong focus on NCQA, URAC, and CMS standards to drive revenue cycle success.

Qualifications

• 5+ years of direct healthcare credentialing and insurance contracting experience.
• Progressive leadership or management oversight experience.
• Knowledge of NCQA, URAC, CMS standards and payer portals.

Responsibilities

• Provider Credentialing & Enrollment across networks.
• Oversee full lifecycle of credentialing, re-credentialing, and roster management.
• Maintain accuracy in CAQH Proview, PECOS, NPPES and Medicaid portals.
• Design systems for timely license, malpractice, DEA, and revalidation tracking.
• Review, redefine, and manage MCO contracts and fee schedules.
• Collaborate with billing and finance to audit enrollment denials.
• Build KPI tracking and write standard operating procedures.

Skills

Provider credentialing

Contracting negotiations

Leadership

Education

Bachelor’s degree in Healthcare Administration

Bachelor’s degree in Business Management

CPCS

CPMSM

Job description

CF Outsourcing Solutions is seeking a Credentialing and Contracting Manager to oversee provider enrollment, network participation, and insurance contract negotiations. You will ensure accurate credentialing and enrollment with payers while optimizing reimbursement terms and maintaining regulatory compliance.

The role requires leadership across credentialing, enrollment operations, and payer relations, with strong focus on NCQA, URAC, and CMS standards to drive revenue cycle success.