Credentialing Specialists

Civicom Global Solutions offers the outsourcing of administrative and operations services to corporations. We offer a wide variety of services so that our clients can focus on other things while we do the job for them – an instant extension of their office. Credentialing Specialists are responsible for processing credentialing applications, that is, to establish eligibility/legitimacy of licensed medical professionals for insurance companies. The tasks include but are not limited to database management, verification of data, preparation of application, and coordination with internal departments and / or external entities. With attitude and ability at the top of our mind, we need people with similar or equivalent experience whether in industry, function, or educational background. While some training will be given to the right people, we need those who can hit the ground running.
As part of this exclusive process for one of our clients, the Credentialing Specialist is tasked to:
  • Meet with Providers to discuss contracting and insurance requirements
  • Process provider credentialing information, verify data in accordance with policies and procedures
  • Prepare and submit all appropriate applications and required supporting documentation
  • Follow-up with insurance companies to ensure timely processing of applications and contracts
  • Educate providers on credentialing and contracting guidelines and requirements
  • Maintain credentialing database and track all direct provider contract data
  • Perform primary and secondary source verifications of credentials according to departmental policy
  • Facilitate monthly and or weekly meetings with insurance provider representatives to ensure escalated issues are handled and resolved in a timely manner
  • Run daily production and task inventory, discuss with management appropriate course of action to maintain work load and productivity requirements
  • Ensure production goals are met while maintaining quality

Apply in

Apply in

  • At least one (1) year of experience working in a similar role
  • Familiar with CredentialMyDoc, CAQH, and EMR systems
  • 2-year degree or equivalent work experience
  • Excellent command of the English language both written and spoken is a must
  • Excellent email and phone skills, and ability to engage with clients WITHOUT a script
  • Ability to meet deadlines, prioritize, organize and manage multiple projects.
  • Ability to escalate as needed
  • Ability to work well independently and as a team member
  • Ability to exercise flexibility, initiative, and good judgment
  • Detail-oriented
  • Strong work ethic and integrity
  • Computer proficiency with proficiency in CRM Tools, MS Office applications including Outlook email
  • Willingness to comply with privacy and compliance regulations
  • With reliable internet connection and a secure dedicated work space at home (for temporary remote setup)

If you’re the right one, you can expect:

  • Full-time employment and an opportunity to be regularized in as short as 3 months;
  • A competitive salary package based on your work experience and skills;
  • HMO coverage upon regularization;
  • Company-sponsored gym membership upon regularization;
  • Quarterly Performance Bonus;
  • Perfect Attendance Bonus;
  • 10 accrued Sick Leave credits in a year — unused ones are commutable to cash; and
  • 10 Vacation Leave credits in a year, among others.