Credentialing & CVO - Hybrid/Remote

1 Month ago • 2-5 Years

Job Summary

Job Description

We are seeking an experienced and strategic professional for the role of Credentialing and Credential Verification (CVO). This position offers significant learning and growth opportunities for individuals aiming to expand their expertise in consultative credentialing services for top global talent. Key responsibilities include managing end-to-end licensing, CVO, credentialing, and privilege processes to ensure compliance. The role involves processing physician accreditation, managed care, governmental and commercial insurance enrollment, and re-credentialing. Daily provider data management, review of credentialing files for accuracy, and analysis of local payor IPA markets are crucial. The role also includes performing primary source verification, maintaining provider credential databases, preparing analytical reports, responding to provider inquiries, and collaborating with internal departments. Additionally, the position requires mentoring the team, maintaining payer relationships for contract negotiation, managing client relationships, and developing policies and procedures to maintain credentialing excellence. Staying updated on accreditation and certification requirements and providing thought leadership through best practices adoption are also key aspects of this role.
Must have:
  • End-to-end Licensing/CVO, Credentialing, and Privilege processes
  • Process physician accreditation and insurance enrollment
  • Daily provider data management
  • Primary source verification
  • Manage provider credential database
  • Prepare analytical reports
  • Respond to provider inquiries
  • Mentor and coach the team
  • Collaborate with internal departments
  • Manage client relationships
  • Develop and implement policies
  • Bachelor's degree in healthcare administration, Business, or related
  • 2 - 5 years of experience in credentialing
  • In-depth knowledge of credentialing processes
  • Excellent communication skills
Good to have:
  • Master's degree preferred
  • Established relationship with key payers

Job Details

Credentialing & CVO 

We are actively seeking an experienced and strategic professional to take on the role of Credentialing and Credential Verification (CVO). This role provides a significant learning & growth opportunity for someone who is looking to expand their experience in consultative credentialing services working with top talent across the globe. 

Key Responsibilities: 

  • End to end Licensing/ CVO, Credentialing and Privilege processes to ensure compliance with industry standards and regulations. 

  • Process physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing 

  • Daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources 

  • Analyze local payor IPA markets for partnerships or payer contracting opportunities 

  • Perform primary source verification via various state and national sources 

  • Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies 

  • Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity 

  • Responds timely to provider inquiries by letter, phone or internal communication 

  • Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely 

  • Mentor and coach the team to provide highest levels of service and efficiency 

  • Maintain relationships with key Payers to facilitate negotiation of contracts 

  • Collaborate with internal departments to streamline and optimize credentialing operations. 

  • Manage client relationships and provide high customer satisfaction   

  • Develop and implement policies and procedures to maintain the highest standards of credentialing excellence in the internal teams. 

  • Stay informed about changes in accreditation and certification requirements and update processes accordingly. 

  • Provide thought leadership via adoption of best practices based on industry changes and technology adoption. 

Qualifications: 

  • Bachelor's degree in healthcare administration, Business, or a related field; master's degree preferred. 

  • 2 - 5 years of experience in credentialing, with substantial experience 

  • In-depth knowledge of credentialing processes, privileging, and regulatory requirements. 

  • Established relationship with key payers will be a plus 

  • Strong organizational and project management skills. 

  • Excellent communication skills 

  • Skilled in preparing and delivering presentations to C Suite stakeholders. 

Location: Philippines

If you are a dynamic leader with a proven track record in credentialing and are ready to make a significant impact on our organization, we want to hear from you! Join us and be part of a collaborative and innovative healthcare environment. 

To apply, submit your resume to ronel@neolytix.com 

#JobOpportunity #Healthcare#Credentialing#CVO #Credentialing 

Similar Jobs

Mark43 - Sales Development Representative-Public Safety

Mark43

Canada (Remote)
2 Weeks ago
Apple - Senior Product Data Scientist, Media Services

Apple

Cupertino, California, United States (On-Site)
3 Weeks ago
Monzo - Group Product Manager, Business Banking

Monzo

London, England, United Kingdom (Remote)
2 Months ago
GoMotive - Senior Strategy and Operations Manager

GoMotive

London, England, United Kingdom (On-Site)
3 Months ago
SEGA - Senior Development Manager

SEGA

Horsham, England, United Kingdom (Hybrid)
1 Month ago

Get notifed when new similar jobs are uploaded

Similar Skill Jobs

Simcorp - Finance Business Partner

Simcorp

Copenhagen, Denmark (Hybrid)
1 Year ago
Rocket Science - Full Stack Engineer

Rocket Science

Cardiff, Wales, United Kingdom (Hybrid)
3 Weeks ago
Bosch Group India - Field Service Engineer / Executive

Bosch Group India

Bengaluru, Karnataka, India (On-Site)
2 Months ago
Unity - Senior Technical Program Manager, Localization (APAC)

Unity

Seoul, South Korea (On-Site)
3 Weeks ago
Bungie - Destiny 2 Global Franchise Director

Bungie

Bellevue, Washington, United States (Hybrid)
2 Months ago
Ceragon Networks - Sales Manager

Ceragon Networks

Mexico (On-Site)
1 Week ago
Rockstar Games - Development Support: Game Live Operations

Rockstar Games

Edinburgh, Scotland, United Kingdom (On-Site)
2 Months ago
Virtusa - Progress 4GL Architect

Virtusa

Gurugram, Haryana, India (Hybrid)
10 Months ago
GoMotive - Manager, AI Systems and Monitoring

GoMotive

Pakistan (Remote)
1 Month ago
Pay2 - Engineering Manager (Web Frontend)

Pay2

Gurugram, India (On-Site)
1 Month ago

Get notifed when new similar jobs are uploaded

Jobs in Philippines

Oliver Agency - Art Director

Oliver Agency

Manila, Metro Manila, Philippines (On-Site)
1 Month ago
deel. - HR Experience Specialist

deel.

Philippines (Remote)
1 Week ago
Nice - Project Manager, PMO

Nice

Manila, Metro Manila, Philippines (Hybrid)
1 Month ago
Power Integrations - Power Supply Design Engineer

Power Integrations

Pasig, Metro Manila, Philippines (On-Site)
5 Months ago
WebFX - Remote Copywriter: Legal

WebFX

Philippines (Remote)
9 Months ago
Telastra - Finance Specialist (CPA/CA Qualified)

Telastra

Makati City, Metro Manila, Philippines (Hybrid)
2 Weeks ago
hogarth - Digital Project Manager

hogarth

Manila, Metro Manila, Philippines (On-Site)
2 Months ago
Power Integrations - Systems & Infrastructure Applications Engineer

Power Integrations

Pasig, Metro Manila, Philippines (On-Site)
10 Months ago
Oliver Agency - GenAI Creative Optimisation Analyst (Senior Data Analyst)

Oliver Agency

Manila, Metro Manila, Philippines (Hybrid)
1 Week ago
ISS Stoxx - Corporate Governance Research Associate

ISS Stoxx

Makati City, Metro Manila, Philippines (Hybrid)
1 Year ago

Get notifed when new similar jobs are uploaded

Similar Category Jobs

Looks like we're out of matches

Set up an alert and we'll send you similar jobs the moment they appear!