- Initiates and coordinates the acquisition and receipt of all credentialing documentation from new and existing providers provides follow-up and problem resolution as required.
- Coordinates processing and distribution by sending correct and complete documentation for each participating physician or healthcare professional to the appropriate hospitals, licensing boards and insurance companies (including subcontracted entities) in a timely manner and follows up on status of process.
- Maintains and ensures strict confidentiality of files and databases.
- Provides medical staff offices and insurance companies with everything needed to complete the credentialing process efficiently and effectively. Acts as a liaison between the physician being credentialed and agency completing the credentialing to ensure timeliness of credentialing process.
- Develops and maintains a system to monitor all date sensitive credentialing documentation for re-certification and expiration dates to ensure maintenance of current status. Notifies physicians and administration of impending expiration dates and/or information update requests.
- Reviews provider directories supplied by the insurance companies to ensure all provider listings are complete and correct.
- Notifies, in writing, insurance company of any necessary corrections and follows up to ensure corrections are made.
- Maintains good consistent oral and written communication and works to establish and maintain good business relationships with insurance companies, regulatory agencies, hospital medical staff, office personnel, clinic managers, physicians, department chairs, other WC HEALTH staff and government agencies.
- Maintains and distributes regular written updates on the credentialing process including, but not limited to, insurance contracts by doctor list and WC HEALTH contracted insurance grid to appropriate personnel, including but not limited to, administrators, department chairs, billing and WC HEALTH administration.
- Meets with candidates for faculty positions to establish contact and distribute credentialing protocols and information.
- Management of Modio or other computerized credentialing software database
- Bacheloru0027s Degree in any field.
- Knowledge of medical provider credentialing and accreditation principles, processes, procedures, regulations, standards, state licensing requirements and documentation.
- Working knowledge of physician specialties and service delivery.
- Working knowledge of CAQH, Medicare, Medicaid, Tricare, third party payers and insurance companies.
- Excellent Communication Skills (both written and verbal)
- Ability to write reports and general business correspondence.
- Possess strong knowledge of state, federal and local regulatory bodies and/or guidelines for credentialing.
- Proficient in using MS Office Applications
- Ability to cross-train others when needed to ensure continuation of credentialing process.
- Ability to maintain confidentiality and follow regulatory guidelines. Maintains patient, providers, workplace and co-worker privacy and confidentiality.
- Ability to work with physicians and others in a highly professional manner and maintain good working relationships.
- Strong organizational and time management skills.
- Amenable to work on Night Shift.
- Amenable to Work On-Site (Eastwood)
-
Credentialing Specialist
2 araw ang nakalipas
Microsourcing Philippines Inc Pasig City, Pilipinas Buong orasWith over 7,000 professionals across 9 delivery centers in the Philippines, MicroSourcing remains the country's largest offshoring solutions provider. · Credentialing Specialist, be 100% YOU with MicroSourcing · The Credentialing Specialist will be responsible for the credentia ...
-
Talent Acquisition Specialist
2 linggo ang nakalipas
MicroSourcing Quezon City, Pilipinas Buong oras· Position Purpose: · The Talent Acquisition Specialist for Specialized Hiring will be identifying, attracting, and hiring the best talent for all tracks assigned and ensures the timely and effective completion of the client's hiring requirements as per agreed hiring process an ...
-
Training Specialist
2 araw ang nakalipas
Polytechnic University of the Philippines Philippines, Quezon City, Pilipinas Buong orasDescription: · We're seeking a passionate Training Specialist who thrives on empowering individuals to reach their full potential. If you're dedicated to fostering growth and development in others, come be a part of our mission to inspire excellence. · Duties and Responsibilities ...
-
Prior Authorization Specialist
2 araw ang nakalipas
BizForce Philippines, Quezon City, Pilipinas Buong oras#1 PH Workforce Delivering to the US · MedCore Solutions, the Medical Division of Bizforce, is seeking a skilled Prior Authorization Specialist - Behavioral Health to join our growing team. The Prior Authorization Specialist we be primarily responsible for obtaining all types of ...
-
Medical Biller
2 araw ang nakalipas
Neolytix Philippines, Quezon City, Pilipinas Buong orasJob Description · About Neolytix · Neolytix is a boutique Consulting and Management Services Organization that works with small & medium-sized healthcare providers across the United States. Our portfolio of services caters to micro verticals and is built on the expertise we have ...
-
Quality Assurance Specialist
2 araw ang nakalipas
Polytechnic University of the Philippines Quezon City, Philippines, Pilipinas Buong orasDescription: · Seeking a meticulous Quality Assurance Specialist to ensure excellence in our products/services. If you're detail-oriented with a passion for maintaining high standards, we want you on our team · Duties and Responsibilities: · 1. Monitor and review calls conducted ...
-
Sr. Talent Acquisition Specialist
2 araw ang nakalipas
MicroSourcing Quezon City, Philippines, Pilipinas Buong orasThe Talent Acquisition Specialist will be responsible for the End-to-End Hiring process for all tracks assigned and ensures the timely and effective completion of the client's hiring requirements as per agreed hiring process and turnaround time. · This person is responsible for t ...
-
Senior Talent Acquisition Specialist
2 araw ang nakalipas
MicroSourcing Quezon City, Philippines, Pilipinas Buong orasThe Talent Acquisition Specialist will be responsible for the End-to-End Hiring process for all tracks assigned and ensures the timely and effective completion of the client's hiring requirements as per agreed hiring process and turnaround time. · This person is responsible for t ...
-
MS Back Office Specialist
3 araw ang nakalipas
VeritasPay Philppines Inc. Pasig, Pilipinas ContractMS BACK OFFICE SPECIALISTThe Merchant Back-office Specialist will handle end-to-end merchant onboarding journey from merchant registration to merchant orientation. He/she will work with the Head of Back-office and other departments to ensure seamless onboarding process.DUTIES AND ...
-
Substance Use Disorder Program Coordinator
2 araw ang nakalipas
MicroSourcing Philippines, Pasig City, Pilipinas Buong orasPosition Summary: · This position is responsible for coordinating with the Program Manager to ensure client engagement and measurement data is tracked in accordance with the needs of the program and its anticipated goals. The Coordinator supports the Substance Use Disorders (SUDS ...
-
Credentialling Specialist
1 linggo ang nakalipas
Elevate Calls Inc Manila, PilipinasJob Title: Credentialing Specialist (Healthcare Account) · Company: Elevate Calls Inc. · Location: Remote (Permanent Work From Home Position) · Position Overview:We are seeking a dedicated and detail-oriented Credentialing Specialist to join our team. As a Credentialing Specialis ...
-
Facebook Ads Manager
1 linggo ang nakalipas
If & When Social Media Agency Manila, PilipinasEntitlements: · Start Date: (Or your earliest start date) · Job Title: Facebook Ads Specialist · Working hours: Full time · 8:00 am - 5:00 pm (Manila Time), Monday - Friday · Fixed weekends off · Remuneration - 60,000 PHP / Month - Hedged in Aud at the date of employment. · Pay ...
-
Revenue Cycle Operations Manager
2 araw ang nakalipas
Microsourcing Philippines Inc Metro Manila / NCR, Pilipinas Buong orasManager is responsible for managing the Insurance Accounts Receivable Representative's primary responsibility is to provide the highest quality of customer service and accounts receivable management to our patients by embracing the Well Care Guiding Principles. The representative ...
-
Partnerships Specialist
2 araw ang nakalipas
UNICEF Manila, PilipinasUNICEF · UNICEF works in over 190 countries and territories to save children's lives, defend their rights, and help them fulfill their potential, from early childhood through adolescence. · At UNICEF, we are committed, passionate, and proud of what we do. Promoting the rights of ...
-
Learning and Development Specialist
2 araw ang nakalipas
Filinvest Development Corporation Taguig, Philippines, Pilipinas Buong orasFilinvest Development Corp. (FDC) is one of the leading, stable and diversified conglomerates in the Philippines. Through its diverse businesses, FDC has established a strong reputation as a dependable partner in economic development. FDC currently has strategic holdings in key i ...
-
USRN Training Specialist
2 araw ang nakalipas
Shearwater CPO® - Home of Clinicians Philippines, Taguig, Pilipinas Buong orasLet your Passion Lead You at the Home of Clinicians with over 4000+ employees who have trusted us with their careers · Our Clinicians and Associate advocates for better patient care while enjoying these benefits: · HMO on Day 1 with 2 dependents upon regularization · Group Life I ...
-
Inpatient Quality Specialist
2 araw ang nakalipas
Tenet Healthcare Taguig, Philippines, Pilipinas Buong orasBenefits: · HMO with FREE 3 dependents · Group life insurance · 10% Annual Performance Incentive · Annual Appraisal · 20 Paid Time Off (PTO) per year · Relocation package available · Work Arrangement · Permanent work from home setup · Qualifications: · At least 4-5 years of exper ...
-
Account Specialist
2 araw ang nakalipas
Baker McKenzie Taguig, Philippines, Pilipinas Buong orasThe Account Specialist I, Office Support will work with the Supervisor in the operational tasks, particularly in workload management. They will also be involved in some quality-related tasks as but not limited to internal quality audits and client-reported incidents. · The role h ...
Credentialing Specialist - Quezon City, Philippines, Pilipinas - MicroSourcing
Paglalarawan
The Credentialing Specialist will be responsible for the credentialing, privileging, licensing of practice plan faculty in accordance with established regulatory and policy requirements. This is a highly confidential position and due care is required to secure confidential information. Responsible for the timely completion and submission of required documentation for each required entity including hospitals, state and federal licensures and health plans.A Credentialing Specialist is expected to:
