Credentialing Specialist

Job Description

About Us:

Outsourced is a leading Philippines outsourcing company providing dedicated remote staff and offshore staffing services. We specialise in providing staff of the highest quality who will continue to exceed your expectations and provide benchmark offshore solutions to your business. With Outsourced you can scale your organisation quickly, easily and cost effectively with dedicated remote staff based in our modern offices in Manila.

Position Overview

We are seeking an experienced and highly detail-oriented Credentialing Specialist to oversee and manage the end-to-end credentialing process for healthcare providers across a growing multi-site practice. This role is responsible for ensuring providers are properly credentialed, re-credentialed, and maintained with insurance payers, while ensuring compliance and minimizing disruptions to billing and patient care.

The ideal candidate has strong healthcare credentialing experience, excellent organizational skills, and the ability to independently manage high-volume credentialing operations while coordinating with providers, payers, and internal stakeholders.

Key Responsibilities Provider Credentialing & Enrollment

• Manage initial credentialing and enrollment for new healthcare providers with all in-network insurance payers.
• Submit credentialing applications and monitor progress through completion.
• Coordinate provider onboarding requirements related to credentialing and payer enrollment.
  
  

Credentialing Maintenance & Compliance

• Manage provider re-credentialing processes and proactively monitor expiration timelines.
• Maintain credentialing calendars to ensure no lapses in provider credentials or payer enrollments.
• Ensure provider records remain compliant with payer and regulatory requirements.
  
  

Provider Data Management

• Create, update, and maintain provider profiles across credentialing platforms such as:
• CAQH
• MCC
• PECOS
• NPPES
• Insurance payer portals
• Ensure all provider information remains accurate, current, and audit-ready.

Payer Relations & Issue Resolution

• Communicate directly with insurance payers regarding credentialing applications, status updates, and follow-ups.
• Investigate and resolve credentialing-related billing issues affecting claims processing.
• Escalate credentialing risks or delays that may impact provider billing or patient access.
  
  

Reporting & Process Management

• Track credentialing progress and maintain detailed reporting on:
• Pending credentialing applications
• Re-credentialing deadlines
• Compliance gaps
• Credentialing risks
• Identify process improvements to streamline credentialing workflows and reduce delays.

Cross-Functional Coordination

• Collaborate with internal billing and clinical teams regarding credentialing-related matters.
• Provide regular status updates to leadership regarding provider credentialing activities.
• Support business continuity by ensuring providers remain active and billable without interruption.
  
  

Qualifications & Requirements

• Minimum 3 years of healthcare credentialing experience.
• Proven experience managing credentialing for 50+ healthcare providers or large provider panels.
• Strong understanding of healthcare credentialing workflows and payer enrollment processes.
• Experience working with insurance payers and provider enrollment systems.
• Familiarity with healthcare credentialing platforms including:
• CAQH
• PECOS
• NPPES
• Insurance payer portals
• Ability to independently manage credentialing operations with minimal supervision.
• Strong attention to detail and ability to manage multiple deadlines simultaneously.
• Experience handling credentialing-related billing issues and payer communication is highly preferred.
• Comfortable working in a remote and fast-paced work environment.

Preferred Experience

• Experience credentialing providers within multi-site healthcare organizations.
• Familiarity with commercial insurance payers and Medicaid credentialing processes.
• Experience managing high-volume provider panels.
• Ability to work independently in a fully remote environment.
  
  

Position Particulars:

Home-based, Tuesday to Saturday from 10PM - 7AM PHT

Note

As part of our recruitment process, we conduct a background check on all hired candidates. Please ensure that all required documents are prepared and submitted promptly.

In compliance to data privacy law, make sure that the following is included at all times:

By clicking on the "I'm Interested" button I hereby allow Outsourced Quality Assured Services, Inc. ("Outsourced") to store and collect my personal information for the purposes of employment application. As such, I agree and authorize Outsourced to collect, store, or continue to use my personal information for the above-stated purpose, and to retain my personal information for a period of 1 year, and for these purposes only.

---