Credentialing Agent- Medical Coding and Billing Focus (Permanent WFH)) - Muntinlupa

Credentialing Agent (Medical Coding & Billing Focus)

We are seeking a detail-oriented and highly organized Credentialing Agent with strong experience in medical coding and medical billing to join our healthcare administration team. The ideal candidate will manage the credentialing and recredentialing processes for healthcare providers while ensuring full compliance with regulatory standards and payer requirements.

• Manage end-to-end credentialing and recredentialing processes for physicians, nurse practitioners, and other healthcare providers.
• Collect, verify, and review provider information such as education, training, licensure, board certification, work history, and references.
• Maintain accurate and up-to-date credentialing files and documentation in compliance with NCQA, CMS, and other regulatory standards.
• Interface with insurance companies, medical groups, and regulatory bodies to ensure timely approval and participation in networks.
• Utilize expertise in medical coding (ICD-10, CPT, HCPCS) to ensure accurate documentation and align credentialing data with billing practices.
• Leverage knowledge of medical billing workflows and payer requirements to prevent denials related to credentialing or provider enrollment.
• Monitor credentialing status and maintain databases to track expirables such as licenses, certifications, and insurance.
• Assist with audits and prepare reports related to provider credentials and compliance.

• Proven experience in medical credentialing, with at least 1+ years in a credentialing agent role.
• Strong background in medical coding and billing (ICD-10, CPT, HCPCS, insurance claims, etc.).
• Familiarity with credentialing software (e.g., CAQH, Availity, Verity, or similar).
• In-depth understanding of healthcare compliance regulations, including CMS, NCQA, and state-specific laws.
• High attention to detail, strong organizational skills, and the ability to manage multiple priorities.
• Excellent communication and interpersonal skills for coordinating with providers and payers.

About Virtual Staffing Solutions

We specialize in delivering innovative solutions and exceptional services to meet the diverse needs of our clients. With a strong commitment to quality and customer satisfaction, we strive to exceed expectations and drive success in every project we undertake.