Credentialing Specialist

🔥 0 minutes ago

🇵🇭 Philippines – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Credentialing Specialist

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sourcefit

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

📣 Marketing

📦 Logistics

🏥 Healthcare

Marketing • Logistics • Healthcare

Sourcefit is a leading business process outsourcing company with headquarters in the Philippines and offices in the Dominican Republic, Armenia, Madagascar, and South Africa. Founded in 2009, Sourcefit specializes in providing custom offshore and nearshore staffing solutions across various industries including IT, Finance, Healthcare, Retail, and more. They focus on offering efficient and cost-effective BPO services such as telesales, customer support, content moderation, IT support, web development, and more. Sourcefit is committed to building long-term value for organizations through customized, efficient, and integrated offshore staffing solutions.

📋 Description

• Manage initial provider credentialing and recredentialing with commercial insurance companies, Medicare, Medicaid, and other contracted payers • Complete and track payer enrollment applications from submission through approval • Add and update providers, supervising physicians, practice locations, and services in payer contracts • Maintain credentialing information in CAQH, NPPES, PECOS, state licensing boards, DEA registrations, malpractice coverage, AthenaOne, and other systems • Monitor expiration dates and complete renewals, revalidations, and credentialing maintenance to prevent participation lapses • Coordinate credentialing and payer enrollment for newly hired providers • Follow up with insurance companies and credentialing organizations regarding application status, documentation, and enrollment issues • Research payer-specific requirements and communicate updates to leadership • Maintain accurate credentialing files, documentation, and tracking systems • Assist with credentialing audits and payer requests for additional documentation • Identify and communicate issues that could affect provider participation • Review and maintain payer contracts and provider participation information • Serve as primary contact for credentialing-related communication with payers and enrollment representatives • Maintain professional payer relationships and follow up on outstanding matters • Collaborate with providers and leadership to obtain required documentation • Assist leadership with research on new insurance networks and payer participation opportunities • Ensure providers are enrolled with applicable payers before providing services requiring insurance participation • Maintain confidentiality and comply with HIPAA, Federal, State, and payer requirements • Recognize and support patients' rights and responsibilities while respecting privacy and confidentiality • Undertake additional credentialing, payer relations, and administrative projects as assigned

🎯 Requirements

• High school diploma or General Education Degree (GED) equivalent • Minimum of 3 years of dedicated medical provider credentialing experience required • Demonstrated experience independently managing provider credentialing from application through payer approval and ongoing maintenance • Hands-on experience with CAQH, NPPES, PECOS, Medicare and Medicaid enrollment, commercial insurance credentialing and contracting, state licensing, and DEA registrations • Experience managing provider recredentialing, payer revalidations, and credentialing renewals • Experience communicating directly with commercial insurance companies and payer enrollment representatives • Behavioral health and/or addiction medicine credentialing experience strongly preferred • Experience with AthenaOne or other healthcare EMR/practice management systems preferred • Ability to independently manage multiple providers, payers, applications, deadlines, and credentialing requirements • Excellent verbal and written communication skills with the ability to work effectively with providers, insurance representatives, credentialing organizations, and internal staff • Strong organizational skills with exceptional attention to detail • Self-directed, dependable, and able to work independently while managing multiple priorities and deadlines • Proficiency in Microsoft Office, including Outlook, Word, and Excel

🏖️ Benefits

• Work from Home • Monday to Friday schedule • Flexible schedule to an extent • U.S. holidays observed