Credentialing & CVO - Hybrid/Remote

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 

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