Deskripsi Pekerjaan
Tenet Global Business Center, Inc. is seeking a meticulous and highly organized Credentialing Specialist to join our dynamic team in Bonifacio Global City (BGC). As a key player in our healthcare operations, you will be responsible for the end-to-end credentialing process for physicians and allied health professionals, ensuring they meet the stringent standards required to provide top-tier patient care.
In this role, you will act as a guardian of compliance and quality, managing the verification of education, training, licensure, and professional history. You will work closely with clinical leadership and administrative teams to maintain an up-to-date and accurate provider database. This position offers a professional environment where your attention to detail directly impacts the safety and efficiency of global healthcare services.
We are looking for a professional who thrives in a fast-paced environment and possesses a deep understanding of the US healthcare landscape. At Tenet GBS, we value excellence and provide a platform for career growth within a globally recognized healthcare services organization. If you have a passion for healthcare administration and a commitment to accuracy, we invite you to build your career with us.
Tanggung Jawab
- Manage the full lifecycle of credentialing and re-credentialing applications for physicians and allied health staff.
- Perform primary source verification of all professional credentials, including medical licenses, DEA certifications, and board certifications.
- Maintain and update provider profiles in the CAQH (Council for Affordable Quality Healthcare) database and internal tracking systems.
- Ensure all credentialing files are compliant with NCQA, The Joint Commission, and CMS standards.
- Coordinate with insurance providers and managed care organizations to facilitate provider enrollment in health plans.
- Identify and flag any discrepancies or adverse information during the verification process for review by the Credentialing Committee.
- Track expiration dates for licenses and certifications, ensuring timely renewals to prevent any lapse in provider eligibility.
- Generate and distribute credentialing status reports to hospital leadership and relevant stakeholders.
Kualifikasi
- Bachelor’s degree in Healthcare Administration, Business Administration, or a related field.
- At least 2-3 years of experience in healthcare credentialing, preferably within a US-based healthcare system or BPO.
- In-depth knowledge of NCQA, URAC, and Joint Commission credentialing standards.
- Proficiency in using credentialing software and provider databases like CAQH, NPDB, and PECOS.
- Exceptional attention to detail and ability to handle sensitive, confidential information.
- Strong communication skills, both written and verbal, for effective coordination with medical professionals and external agencies.
- Proven ability to meet strict deadlines and manage high volumes of documentation accurately.
- CPCS (Certified Provider Credentialing Specialist) certification is a significant advantage.