Job Description

Healthcare Provider Credentialing Specialist

Location: Makati, Valero

Schedule: Monday–Friday | between 9pm and 8am MNL

Work Setup: Remote

The Healthcare Provider Credentialing Specialist 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 Provider Credentialing Specialist 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.

Requirements

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

• HMO (Medical and Dental Coverage) on Day 1 with 1 Free Dependent
• Company-provided equipment
• 13th Month Pay
• Internet Allowance

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStream TM, to help with traceability, governance, and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.