• Adhere to NCQA guidelines. • Audit Provider Licensure Files to NCQA guidelines. • Pull Monthly Delegated Verification Files in accordance with NCQA. • Knowledge of Delegated Verification Websites (ie. National Provider Data Base, etc.). • Understanding of Initial and Re-Credential Delegated files / processing. • Prepare and Present provider files for internal and external auditing. • Upload and update the system and / or software with new documents. • Request & Obtain any Licensure renewals. • Must be able to utilize the licensure portals. • Experience in Clearinghouse / Manual Education Verifications. • Experience in Manual Hospital Privileges Verifications. • Experience in Board Certification Verifications through the appropriate portals. • Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.). • Knowledge of what a Credentialing Committee consists of. • Coordinate, monitor, maintain and process all internal re-credentialing to NCQA guidelines. • Heavy Understanding of Attestation questions, actions, exclusions and explanations. • Ability to speak effectively with providers, educators and internal departments. • Assist offices and internal departments with credentialing issues. • Ability to multi-task in a fast-paced environment. • Work other projects as assigned.

• This role is responsible for end-to-end provider credentialing and payer enrollment across government and commercial payers, ensuring providers are set up for success in a multi-state, virtual care environment. • Complete and manage all aspects of initial credentialing, re-credentialing, and payer enrollment for a large network of telehealth providers across the U.S. • Submit and track applications with government payers (Medicare, Medicaid, VA, Tricare) and commercial/private payers to ensure active participation status. • Lead and mentor credentialing staff, providing training, guidance, and quality checks. • Serve as the subject matter expert (SME) for credentialing, payer enrollment, and their connection to revenue cycle processes • Optimize credentialing turnaround time and reduce payer enrollment delays that impact revenue • Stay up to date on payer regulations and credentialing requirements across all states where the organization provides telehealth services • Analyze denial trends related to credentialing/enrollment issues and implement corrective actions • Track payer roster accuracy and manage data integrity between credentialing systems and billing systems. • Maintain accurate provider records in credentialing systems (e.g., CAQH, payer portals, internal databases), ensuring information is current and compliant. • Verify provider credentials including education, training, board certification, work history, malpractice history, and references. • Ensure provider enrollment aligns with billing requirements, reducing claim denials and reimbursement delays for a streamlined Revenue Cycle Management (RCM) process • Monitor payer rosters and enrollment timelines to proactively resolve issues that may impact revenue. • Support the onboarding of new providers by ensuring credentialing and enrollment are completed prior to patient scheduling. • Prepare reports on credentialing status, payer enrollment progress, and upcoming expirations for leadership and compliance purposes. • Assist with audits, quality checks, and process improvements to ensure compliance.

• Work From Anywhere in the Philippines • Work Schedule: US Timezone (Flexible) │ Overlap with US business hours for payer follow-ups • Submit and track credentialing applications across Medicaid, Medicare, and commercial payers • Manage CAQH profiles and follow up directly with payers to resolve issues • Achieve same-day to next-day application turnaround with clean first-time submissions

• Verify provider credentials through approved sources in a timely and accurate manner • Track and process credentialing and re-credentialing applications • Enter and update provider information in the credentialing database • Maintain and update provider demographics • Monitor and manage data from delegated entities • Communicate with providers or their office staff regarding credentialing status and required documentation • Identify and report non-compliance or credentialing issues to the supervisor • Ensure confidentiality of sensitive data and documents • Perform other duties as assigned