Healthcare Licensing and Credentialing Specialist
New
G
Global Finance TeamsHealthcare
Philippines. Metro Manila, Philippines, US hoursFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 2+ years
- Required Skills
- Microsoft OfficeHIPAA
Requirements
- Experience in healthcare credentialing or provider enrollment preferred.
- 2+ years in Behavioral Health credentialing
- Experience working in Modio credentialing database
- Knowledge of CAQH, PECOS, and payer requirements
- Strong attention to detail, organization, and communication skills.
- Proficient with Microsoft Office and credentialing systems.
Responsibilities
- Collect and verify provider documents (licenses, education, certifications, malpractice, etc.).
- Process credentialing and re-credentialing applications with payers (Medicare, Medicaid, commercial plans).
- Maintain provider files, databases, and systems (e.g., CAQH, NPPES, PECOS).
- Track expirations and ensure timely renewals.
- Communicate application status and requirements to providers and internal teams.
- Ensure compliance with HIPAA, NCQA, Joint Commission, and other regulations.
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