Credentialing Specialist/ Provider Enrollment (Associate) - Hybrid on Eastwood

Credentialing & CVO

We are actively seeking an experienced and strategic professional to take on the role of Credentialing and Credential Verification (CVO). This role provides a significant learning & growth opportunity for someone who is looking to expand their experience in consultative credentialing services working with top talent across the globe.

Key Responsibilities:

• End to end Licensing/ CVO, Credentialing and Privilege processes to ensure compliance with industry standards and regulations.
• Process physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing
• Daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources
• Analyze local payor IPA markets for partnerships or payer contracting opportunities
• Perform primary source verification via various state and national sources
• Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies
• Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity
• Responds timely to provider inquiries by letter, phone or internal communication
• Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely
• Mentor and coach the team to provide highest levels of service and efficiency
• Maintain relationships with key Payers to facilitate negotiation of contracts
• Collaborate with internal departments to streamline and optimize credentialing operations.
• Manage client relationships and provide high customer satisfaction
• Develop and implement policies and procedures to maintain the highest standards of credentialing excellence in the internal teams.
• Stay informed about changes in accreditation and certification requirements and update processes accordingly.
• Provide thought leadership via adoption of best practices based on industry changes and technology adoption.

Qualifications:

• Bachelor's degree in healthcare administration, Business, or a related field; master's degree preferred.
• 2 - 5 years of experience in credentialing, with substantial experience
• In-depth knowledge of credentialing processes, privileging, and regulatory requirements.
• Established relationship with key payers will be a plus
• Strong organizational and project management skills.
• Excellent communication skills
• Skilled in preparing and delivering presentations to C Suite stakeholders.

Location: Philippines

If you are a dynamic leader with a proven track record in credentialing and are ready to make a significant impact on our organization, we want to hear from you! Join us and be part of a collaborative and innovative healthcare environment.

To apply, submit your resume to [email protected]

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