US Health Insurance Credentialing Specialist

Introduction:
A U.S.-based Healthcare Business in in California, USA, is looking for a proficient and experienced Insurance Credentialing Specialist to manage the credentialing processes for our U.S. operations remotely from the Philippines. This role is crucial for ensuring that our healthcare providers meet all regulatory standards and are compliant with U.S. insurance norms, particularly Medicare and Medi-Cal.

Job Responsibilities:

-Handle the full spectrum of the credentialing process for U.S. healthcare providers, focusing on Medicare and Medi-Cal applications via PECOS and PAVE systems.
-Maintain and update provider data within credentialing databases and ensure all documentation complies with U.S. federal and state regulations.
-Work closely with providers to collect required documents, clarifying and resolving discrepancies in application data.
-Submit and follow up on applications, working diligently to meet deadlines and expedite the credentialing cycle.
-Monitor credentialing statuses and maintain constant communication with U.S. insurance panels to address any issues.
-Ensure adherence to HIPAA and other relevant healthcare compliance regulations.
-Generate and submit reports and support auditing processes as needed.


Required Qualifications:

-Bachelor’s degree in Health Administration, Business Administration, or a related field.
-At least 12 months of direct experience in credentialing, specifically with U.S. insurance providers including Medi-Cal and Medicare.
-Proficiency in using PECOS, PAVE, and other credentialing software, as well as MS Office applications.
-Deep understanding of U.S. healthcare regulations, insurance compliance, and credentialing processes.
-Exceptional organizational and detail-oriented skills.
-Strong communication skills with fluency in English, capable of effectively coordinating with U.S. providers and insurance entities.

Preferred Qualifications:

-Certification as a Provider Credentialing Specialist (CPCS) or similar.
-Previous experience working remotely for a U.S.-based employer.


Benefits:
Paid Major Holidays

-This job is full-time and long-term. Our company has had Philippine-based employees for years. We are proud to provide our staff with a great life-work balance and to offer decent pay. This is the place in which our employees will grow within their field into leadership roles.