Credentialing Compliance Analyst

• 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.

Quote job ref: JN-102026-7119301