Credentialing Specialist

Credentialing Specialist

Location: Pasay City

Work Set Up: Hybrid | Shifting Schedules

Avensys is seeking an experienced Credentialing Specialist to manage end-to-end healthcare provider enrollment and payer credentialing. This role requires a subject matter expert who can independently navigate federal, state, and commercial payer systems from submission to final approval.

Key Responsibilities

Federal & State Enrollment (Medicare/Medicaid)

• Manage full Medicare enrollment via PECOS (CMS-855I, 855B, 855R, DME)
• Handle NPI Type 1 & 2 lifecycle through NPPES
• Submit and track Medicaid applications via state portals
• Manage Identity & Access (I&A) system roles

CAQH & Commercial Credentialing

• Own CAQH ProView profiles (setup, re-attestation, document updates)
• Process commercial enrollments via Availity and payer portals (Aetna, Cigna, BCBS, UHC, Anthem, etc.)