Healthcare Provider Credentialing Specialist

ImageNetLLC

4d•Remote

About The Position

The Healthcare Provider Credentialing Specialist is primarily responsible for coordinating, managing, and maintaining credentialing services for healthcare providers and practices, while establishing and maintaining credentialing relationships with payers and provider networks. This role assists providers in preparing, processing, submitting, and monitoring both paper and electronic credentialing applications and supporting documentation for initial credentialing and recredentialing. The Healthcare Provider Credentialing Specialist will coordinate and communicate with providers and payers to ensure all credentialing requirements are met while managing multiple credentialing accounts from start to finish.

Requirements

College degree preferred (Associate's or Bachelor's degree).
Call Center/BPO experience is required.
At least 2 years of healthcare BPO experience involving provider credentialing.
MUST HAVE provider credentialing experience and familiarity with industry-recognized standards.
MUST HAVE working knowledge of Adobe Acrobat PDF.
Comfortable handling phone, chat, and email interactions.
In-depth knowledge of healthcare terminology, eligibility, benefits, medical/dental claims, and healthcare process flows.
Willing to work shifting schedules, graveyard shifts, holidays, and weekends when required.
Candidate residing in Metro Manila or nearby provinces is preferred.
Stable internet connection of at least 35 Mbps.
Dedicated workspace suitable for remote work.
Can start ASAP.

Responsibilities

Monitor all documents and data exchanged within the credentialing database to ensure quality, accuracy, and timely completion of credentialing processes.
Coordinate with providers to ensure proper enrollment based on individual payer requirements.
Organize, label, maintain, and securely store credentialing forms, applications, and supporting documentation.
Prepare, review, and submit credentialing and recredentialing applications to payers and provider networks.
Monitor credentialing applications and follow up with providers and payers to ensure timely completion.
Train providers and office staff on the use of credentialing applications and services.
Communicate professionally through phone, email, and chat with providers, payers, and internal stakeholders.
Create, edit, and maintain credentialing documents, correspondence, and supporting materials.
Maintain accurate records and documentation throughout the credentialing lifecycle.
Comply with all federal, state, accreditation, client, and company policies and procedures.
Consistently meet departmental productivity, quality, attendance, and service level expectations.
Maintain strict confidentiality of sensitive provider and patient information.
Observe all information security protocols, including secure transmission of confidential data.
Report any security concerns or suspicious activities immediately.
Perform other duties as assigned.