Credentialing Specialist (HealthCare)

Precision keeps healthcare moving

The role behind every approved provider, every cleared claim, and every system that works. This role offers international exposure, hands-on impact in revenue cycle operations, and the chance to make your mark in a highly regulated industry—while staying rooted at home. Step into work that builds expertise, credibility, and long-term career value.

Job Description

As a Credentialing Specialist (Healthcare), you will manage high-volume outbound calls to insurance payors, track application and claim statuses, document all communications, and maintain accurate internal records while following established workflows, scripts, and compliance standards.

Job Overview

Employment type: Indefinite term type contract
Shift: Day shift | 09:00 AM – 06:00 PM | Weekends off
Work setup: Work from home (Colombia)

Exciting Perks Await!

• 5 days work week
• Weekends off
• Work from home arrangement
• 20 vacation days in total
• Prepaid medicine
• Fully customized Emapta laptop and peripherals
• Indefinite term type contract
• Direct exposure to our clients
• Career growth opportunities
• Diverse and supportive work environment
• Prime office locations – Bogotá and Medellín
• Unlimited upskilling through Emapta Academy courses

The Qualifications We Seek

• Ability to complete a high volume of outbound calls
• 1 to 3 years of relevant experience
• Strong verbal communication skills and professional phone etiquette
• Accurate documentation skills with strong attention to detail
• Ability to follow structured workflows and scripts
• Basic proficiency with Microsoft Office and web-based systems (especially SharePoint, Outlook, Teams)
• Comfort learning simple tracking tools
• Ability to manage time and prioritize tasks in a remote work environment
• Experience in customer service and dealing with credentialing, insurance payors, or similar
• Familiarity with credentialing or healthcare administrative processes
• Strong English communication skills
• Familiarity with Microsoft Office, including understanding of SharePoint
• Experience with CRM systems, preferably Monday.com (nice to have, not required)
• Familiarity with CAQH is a plus
• Understanding payer differences (Optum, UHC, Evernorth, etc.) is an advantage

Preferred Skills

• Prior experience in behavioral health credentialing or billing support
• Familiarity with insurance terminology or healthcare processes
• Experience using CRM, EMR, or ticketing systems

Technical Requirements

• Private, secure workspace compliant with HIPAA requirements
• Reliable internet connection and computer
• Ability to communicate with internal teams via chat, email, and video

Your Daily Tasks
Credentialing Support

• Contact insurance payors to obtain application status updates
• Confirm receipt of provider documents, forms, and required materials
• Document all payor responses in internal systems
• Notify Credentialing Specialists of missing information, payor requests, or required follow-ups

Claim Status Support

• Call insurance payors to verify the processing status of claims
• Record details regarding processing timelines, denials, required corrections, or additional information needed
• Communicate findings to Billing team members to support claim resolution
• Log all call outcomes accurately and consistently

Administrative Duties

• Maintain organized records of all calls made and information gathered
• Update spreadsheets, trackers, and portals used by the Credentialing and Billing teams
• Follow all checklists, scripts, and workflow guidelines
• Complete assigned tasks within required timelines

Compliance

• Handle all information in accordance with HIPAA and internal confidentiality standards
• Use approved communication channels and documentation formats

About the Client

Where accuracy, compliance, and care intersect.

Our client operates in the healthcare sector, delivering credentialing and administrative solutions that help providers navigate complex payer requirements. With a strong emphasis on compliance, documentation accuracy, and operational efficiency, our client plays a critical role in keeping healthcare services accessible, timely, and compliant across international systems.

Welcome to Emapta Philippines!

Join a team that values camaraderie, excellence, and growth. Recognized as one of the Top 20 Dream Companies of Filipinos in 2024, Emapta offers stability, competitive opportunities, and international exposure. Work with global clients across industries while staying rooted at home, supported by a collaborative culture that encourages continuous learning, career progression, and meaningful impact. Apply now and be part of the #EmaptaEra!