Credentialing Specialist (US Healthcare)

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Healthcare Customer Service Representative to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you!

Account specific roles and responsibilities

Process initial credentialing, recredentialing, and payer enrollment applications for healthcare facilities and providers
Coordinate with insurance companies, managed care organizations, Medicare, Medicaid, and commercial payers regarding credentialing requirements and application status
Maintain accurate provider and facility records within credentialing databases and tracking systems
Gather, verify, and organize required credentialing documentation such as licenses, certifications, malpractice insurance, W-9s, NPIs, and CAQH profiles
Conduct regular follow-up with payers to ensure timely processing and approval of applications
Monitor credentialing expiration dates and support timely renewals and revalidations
Update and maintain CAQH profiles and payer portals
Review applications for completeness and accuracy prior to submission
Communicate credentialing status updates to internal stakeholders and clients
Assist in resolving credentialing-related issues, denials, or discrepancies
Ensure compliance with payer requirements, company policies, HIPAA regulations, and credentialing standards
Generate reports and maintain credentialing trackers as needed

Requirements

• At least 1 year of experience in US healthcare credentialing, provider enrollment, or insurance verification
• Experience handling facility credentialing and payer enrollment processes preferred
• Familiarity with Medicare, Medicaid, commercial insurance payers, and MCO credentialing processes
• Knowledge of CAQH, NPI, PECOS, and payer portals preferred
• Strong attention to detail and organizational skills
• Excellent written and verbal communication skills
• Ability to manage multiple applications and deadlines simultaneously
• Proficient in Microsoft Office tools, particularly Excel and Outlook
• Must be willing to work on-site in Shaw Blvd, Mandaluyong
• Amenable working night shifts

Benefits

What Can We Offer You?

Competitive salary and benefits

Health Insurance with free dependents*

10%-night differential

Attendance Bonus

Paid Time Off

Convertible to cash leave credits

Performance Appraisal

• Work-life balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our Commitment to You

Strong culture and values-driven leadership

We create opportunities for you to learn and grow at any stage of your career

Continuous learning and innovation

We foster an all-inclusive environment where everyone thrives

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ISTA Solutions is home to rockstar professionals who aim to be engaged in defining and building an employee centric culture, focused on long term success, work-life balance, and life-long learnings. From the industries we support, to the functions we perform, ISTA has structured ourselves differently from other outsourcing companies; effectively setting ourselves apart from the rest of the pack. If you are looking for something new and something different, where you are engaged not only in your own success but in defining and building the culture you want to belong in, you've come to the right place.