Credentialing Compliance Analyst
MICHAEL PAGE INTERNATIONAL RECRUITMENT (PHILIPPINES) INC.- Posted 7 hours ago
- Be among the first 10 applicants
Job Description
- Be part of a growing shared services company in a non profit health care company
- Opportunity to gain pioneering experience in a hybrid work setup
About Our Client
Our client is a leading organization in the U.S. health and safety sector, recognized for its focus on innovation, high-quality patient care, and operational excellence. Its expanding global capability center in Taguig, Philippines offers a stable and mission-driven work environment, multinational collaboration, and strong prospects for long-term career advancement.
Job Description
Key Responsibilities of the Credentialing Compliance Analyst:
- Review and maintain managed care contracts to ensure compliance with organizational standards, regulatory requirements, and approved contract language.
- Serve as a subject matter resource for contract terms, payer policies, reimbursement methodologies, and managed care regulations.
- Maintain accurate contract repositories, fee schedules, and payer policy inventories to support operational consistency and reporting needs.
- Analyze contract language, policy updates, and payer communications to assess business and financial impact.
- Research, document, and resolve payer-related issues, disputes, claims inquiries, and reimbursement concerns.
- Coordinate with internal stakeholders to support contract implementation, compliance monitoring, and operational readiness.
- Prepare reports, summaries, and executive-level analyses regarding managed care agreements and payer performance.
- Identify and implement process improvement opportunities that enhance contract management efficiency, accuracy, and standardization.
The Successful Applicant
Successful Candidate Profile - Credentialing Compliance Analyst
- Bachelor's degree in Business Administration, Healthcare Administration, Finance, Information Systems, or a related field.
- Proven experience within the US healthcare industry, preferably supporting managed care, provider operations, payer relations, healthcare administration, or revenue cycle functions.
- Experience in provider credentialing and enrollment processes, including coordination with health plans, verification of provider information, and maintenance of provider records.
- Working knowledge of managed care contracts, reimbursement methodologies, payer policies, healthcare regulations, and claims processes.
- Familiarity with credentialing, provider data management, contract management, and healthcare information systems.
- Strong analytical and problem-solving skills with the ability to interpret complex healthcare contracts and payer requirements.
- Advanced proficiency in Microsoft Office applications, particularly Excel, Word, PowerPoint, and Outlook.
- Excellent stakeholder management and communication skills with the ability to collaborate across multiple departments and external healthcare partners.
What's on Offer
Join a respected organization in the health and safety industry where your work helps ensure quality care and regulatory compliance. This role offers a hybrid work setup, a night shift schedule, and a competitive compensation package. You'll be part of a team focused on maintaining high standards in provider credentialing and operational excellence.
More Info
Key Skills
provider data management
healthcare information systems
healthcare regulations
payer policies
reimbursement methodologies
claims processes
managed care contracts
About Company
