Credentialing Specialist

• Prepare and submit initial payer enrollment applications for individual providers and group practices for commercial and government plans
• Complete, update, and attest CAQH ProView profiles and keep supporting documents current
• Maintain provider records in PECOS and NPPES, including revalidations, reassignments, and demographic changes
• Track pending applications and follow up with payer provider relations by phone, portal, and email until effective dates are confirmed
• Manage the recredentialing and revalidation calendar to prevent provider lapses with payers
• Collect and maintain credentialing documents, including state licenses, DEA registrations, malpractice certificates of insurance, board certifications, W-9s, and CVs, and track expiration dates
• Submit roster updates, group additions and terminations, and demographic changes to payers
• Document every application, payer contact, reference number, and effective date in the client’s credentialing tracker
• Provide a weekly status report to the client contact and escalate stalled or denied applications
• Protect patient information and follow HIPAA requirements

Credentialing Specialist jobs in Philippines

Credentialing and Payer Enrollment Specialist – Part-time