Credentialing Specialist (Phil)

Job Summary

ExcellentFlow Management Solutions, Inc. is seeking an experienced Credentialing Specialist to manage all aspects of provider credentialing, enrollment, recredentialing, and contract administration. The ideal candidate has a strong understanding of the healthcare credentialing process, payer requirements, and provider enrollment procedures, with the ability to work independently while managing multiple deadlines.

This position requires a minimum of one (1) year of verifiable experience in healthcare provider credentialing. Applicants without credentialing experience will not be considered.

Candidates must be able to provide proof of previous credentialing accomplishments, such as successful payer enrollments, completed credentialing projects, references, or other evidence demonstrating hands-on experience.

Key Responsibilities

• Compile, maintain, and update accurate credentialing records for all healthcare providers.
• Complete and submit provider credentialing, enrollment, and recredentialing applications.
• Monitor application status and proactively follow up with insurance companies, health plans, hospitals, and credentialing organizations until completion.
• Maintain current copies of provider licenses, certifications, DEA registrations, malpractice insurance, board certifications, NPI information, and all other required credentialing documents.
• Track expiration dates for licenses, certifications, malpractice insurance, contracts, and other credentials to ensure timely renewals.
• Maintain provider contract files and credentialing documentation.
• Ensure provider demographic information remains accurate and updated with all health plans, IPAs, medical groups, hospitals, and government agencies.
• Set up, maintain, and update provider information in online credentialing portals and databases.
• Review payer contracts, compare reimbursement terms, summarize key differences, and present findings to management.
• Research payer requirements and remain current on credentialing regulations and industry standards.
• Coordinate with internal departments, providers, clinics, insurance companies, and external organizations to resolve credentialing-related issues.
• Maintain organized electronic records while ensuring confidentiality and compliance with company policies.

Qualifications:

• Minimum of one (1) year of verifiable experience as a Credentialing Specialist is required.
• Applicants without credentialing experience, please do not apply.
• College graduate preferred.
• Experience working with healthcare providers, medical practices, MSOs, IPAs, hospitals, or insurance companies is highly preferred.
• Strong knowledge of provider credentialing, enrollment, and recredentialing processes.
• Experience with CAQH, payer portals, Medicare, Medicaid, and commercial insurance credentialing is preferred.
• Excellent organizational and time management skills.
• Strong analytical and problem-solving abilities.
• Excellent verbal and written communication skills.
• Exceptional attention to detail and accuracy.
• Ability to work independently with minimal supervision.
• Ability to manage multiple providers and deadlines simultaneously.
• Proficiency in Microsoft Office (Excel, Word, Outlook) and internet-based credentialing systems.
• Typing speed of at least 45 words per minute.

Job Type: Full-time

Pay: Php60,000.00 - Php70,000.00 per month

Work Location: Remote