Job Description
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.)
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