Credentialing Specialist / Eastwood / Onsite / Night Shift

Position: Credentialing Specialist
Location: Eastwood Libis Quezon City
Work Set-up & Shift: Onsite | Night Shift

ABOUT THE CLIENT:

Is a leading Modern Business Process Outsourcing (BPO) company dedicated to helping you achieve unparalleled success. Our primary focus is to harness the power of outsourcing and drive your organization towards reaching its goals.

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.

Duties and Responsibilities:

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.

Qualifications:

Bachelor's 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.
Communicates effectively, setting aside personal problems and differences in order to promote a positive and safe work environment.
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.