Credentialing Specialist

• Develop, write, and maintain credentialing policies and procedures aligned with NCQA CVO standards
• Cross-reference policies and procedures to specific NCQA standards and elements
• Prepare and organize documentation for Interactive Review Tool (IRT) submission
• Track and monitor NCQA policy updates, corrections, and clarifications
• Establish and maintain NCQA-required quality improvement processes
• Conduct internal file audits covering 10–20% of closed files
• Prepare mock survey materials and conduct internal readiness assessments
• Collect and analyze QI metrics and prepare certification review reports
• Coordinate survey submission timelines and requirements
• Prepare file samples for NCQA surveyor review
• Support virtual survey logistics and documentation requests
• Address surveyor findings and coordinate corrective action responses

CVO documentation specialist preparing Philippines healthcare credentialing operations for NCQA certification

Credentialing and CVO Documentation Specialist

CVO Documentation & Audit Specialist preparing healthcare credentialing policies, audits, and survey materials for NCQA certification. Hybrid role based in Quezon City, Philippines.

• Manage the end-to-end credentialing process for behavioral health providers.
• Complete, maintain, and update CAQH profiles and supporting documentation.
• Submit and manage payer enrollment and insurance paneling applications.
• Coordinate credentialing across multiple insurance carriers and multiple states.
• Track application progress and proactively follow up with insurance carriers.
• Maintain accurate credentialing records and ensure provider compliance.
• Coordinate provider NPI information and insurance documentation.
• Manage credentialing timelines while identifying and resolving application delays.
• Support revenue cycle operations, including insurance-related administrative workflows.
• Assist with billing processes after credentialing has been successfully established.
• Coordinate with insurance carriers regarding provider enrollment and reimbursement requirements.
• As the practice expands, additional responsibilities may include medical billing, practice marketing support, and additional healthcare administrative functions.

Credentialing & Revenue Cycle Specialist for a U.S.-based behavioral health practice

Behavioral Health Credentialing, RCM Specialist

Credentialing & Revenue Cycle Specialist for a U.S.-based behavioral health practice. Immediate focus on credentialing operations with potential to expand into billing responsibilities.

• Work From Anywhere in the Philippines
• Work Schedule: US Timezone (Flexible) │ Overlap with US business hours for payer follow-ups
• Submit and track credentialing applications across Medicaid, Medicare, and commercial payers
• Manage CAQH profiles and follow up directly with payers to resolve issues
• Achieve same-day to next-day application turnaround with clean first-time submissions

Credentialing Specialist submitting applications for a telehealth company

Credentialing Specialist responsible for managing and submitting provider credentialing applications for a telehealth company. Work from anywhere in the Philippines, focusing on US business hours.

• Perform manual license and certification lookups through state boards, professional licensing bodies, and other approved verification sources.
• Verify information such as full name, date of birth, license number, certification status, expiration dates, and other relevant credential details.
• Review assigned tickets, tasks, or lookup requests and process them according to client-defined workflows.
• Capture screenshots or other approved documentation as evidence of license or certification verification.
• Upload verification results and supporting documentation into the client’s platform or system.
• Ensure all information entered into the system is accurate, complete, and aligned with client requirements.
• Identify and escalate incomplete, inconsistent, expired, unverifiable, or questionable credential records.
• Follow strict confidentiality and data security protocols when handling PII and sensitive information.
• Maintain productivity and turnaround time expectations based on assigned volume and client SLAs.
• Communicate with internal supervisors or client points of contact for clarifications, exceptions, or process updates.
• Support process improvements by identifying recurring issues, workflow gaps, or verification challenges.

Credentialing & License Verification Specialist responsible for verifying licenses and certifications.

Credentialing and License Verification Specialist

Credentialing & License Verification Specialist responsible for verifying licenses and certifications across different sources. Detail-oriented role focused on accuracy and maintaining client documentation standards.

Credentialing Specialist jobs in Philippines

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Credentialing and CVO Documentation Specialist

Behavioral Health Credentialing, RCM Specialist

Credentialing Specialist

Credentialing and License Verification Specialist