Healthcare Credentialing Specialist | WFH

Healthcare Credentialing Specialist 

Position Summary

The Healthcare Customer Service Advocate – Provider Credentialing is primarily responsible for coordinating, managing, and maintaining credentialing services for healthcare providers and practices, while establishing and maintaining credentialing relationships with payers and provider networks. This role assists providers in preparing, processing, submitting, and monitoring both paper and electronic credentialing applications and supporting documentation for initial credentialing and recredentialing. The Healthcare Customer Service Advocate will coordinate and communicate with providers and payers to ensure all credentialing requirements are met while managing multiple credentialing accounts from start to finish.

Essential Job Duties and Responsibilities

· Monitor all documents and data exchanged within the credentialing database to ensure quality, accuracy, and timely completion of credentialing processes.

· Coordinate with providers to ensure proper enrollment based on individual payer requirements.

· Organize, label, maintain, and securely store credentialing forms, applications, and supporting documentation.

· Prepare, review, and submit credentialing and recredentialing applications to payers and provider networks.

· Monitor credentialing applications and follow up with providers and payers to ensure timely completion.

· Train providers and office staff on the use of credentialing applications and services.

· Communicate professionally through phone, email, and chat with providers, payers, and internal stakeholders.

· Create, edit, and maintain credentialing documents, correspondence, and supporting materials.

· Maintain accurate records and documentation throughout the credentialing lifecycle.

· Comply with all federal, state, accreditation, client, and company policies and procedures.

· Consistently meet departmental productivity, quality, attendance, and service level expectations.

· Maintain strict confidentiality of sensitive provider and patient information.

· Observe all information security protocols, including secure transmission of confidential data.

· Report any security concerns or suspicious activities immediately.

· Perform other duties as assigned.

Key Success Factors

· Technically competent, organized, detail-oriented, and customer-focused.

· Demonstrates strong analytical and problem-solving skills.

· Able to quickly learn new processes, systems, and credentialing requirements.

· Confident, creative, self-motivated, and enthusiastic with a proactive approach to work.

· Effectively manages multiple credentialing projects and provider accounts simultaneously.

· Builds and maintains positive working relationships with providers, payers, clients, and internal departments.

· Delivers exceptional customer service with consistently positive feedback.

· Regularly meets productivity, quality, and accuracy expectations.

· Exercises sound judgment and discretion when handling confidential information.

Education, Experience & Skills

Education & Experience

· College degree preferred (Associate's or Bachelor's degree).

· At least 2 years of BPO healthcare experience involving provider credentialing services.

· MUST HAVE provider credentialing experience and familiarity with industry-recognized credentialing standards.

· Previous call center/BPO experience is required.

Technical Skills

· Proficient in Microsoft Office applications (Word, Excel, Outlook, and PowerPoint).

· Proficient in Internet-based applications and online systems.

· MUST HAVE working knowledge of Adobe Acrobat PDF.

· Working knowledge of healthcare terminology, eligibility, benefits, medical and dental claims, and payer processes.

· Working knowledge of technical and procedural aspects of provider credentialing functions.

Core Competencies

· Excellent analytical, organizational, and time management skills.

· Strong attention to detail with a high level of accuracy.

· Excellent written, verbal, and interpersonal communication skills.

· Strong copywriting and business writing skills for credentialing documents, correspondence, and reports.

· Comfortable communicating professionally through phone, email, and chat.

· Ability to exercise a high level of tact and discretion in both internal and external interactions.

· Ability to establish and maintain positive working relationships with internal and external stakeholders.

· Strong multitasking skills with the ability to manage multiple projects and provider accounts simultaneously.

· Ability to prioritize work effectively in a fast-paced environment while maintaining accuracy.

· Ability to solve practical problems and make sound decisions in situations with limited standardization.

· Self-motivated, adaptable, resourceful, and capable of working independently with minimal supervision.

Requirements

· Call Center/BPO experience is required.

· At least 2 years of healthcare BPO experience involving provider credentialing.

· MUST HAVE provider credentialing experience and familiarity with industry-recognized standards.

· MUST HAVE working knowledge of Adobe Acrobat PDF.

· Comfortable handling phone, chat, and email interactions.

· In-depth knowledge of healthcare terminology, eligibility, benefits, medical/dental claims, and healthcare process flows.

· Willing to work shifting schedules, graveyard shifts, holidays, and weekends when required.

· Candidate residing in Metro Manila or nearby provinces is preferred.

· Stable internet connection of at least 35 Mbps.

· Dedicated workspace suitable for remote work.

· Can start ASAP.

Additional Benefits

· Work from Home

· Company-provided equipment

· 13th Month Pay

· Internet Allowance

· HMO (Medical and Dental Coverage)