Admin Analyst (Managed Care and Reimbursement)

Role: Ensuring timely and accurate enrollment, credentialing and re-credentialing for company's hospitals and affiliated entities with commercial and government payers. This role is essential to enabling compliant billing and uninterrupted reimbursement by maintaining accurate provider data, managing payer applications, and resolving enrollment-related issues. As a member of the Reimbursement team within Global Business Services – Manila, this position serves as a key liaison between internal stakeholders and payer organizations, ensuring compliance with regulatory requirements and payer-specific credentialing standards.

Responsibilities:

•  Prepare, submit, and track initial and re-credentialing applications for new and existing entities to ensure timely enrollment with commercial and government payers.
• Monitor credentialing and enrollment status, including expiration dates, to prevent gaps in payer participation and minimize revenue disruption.
• Partner with stakeholders to collect and verify required documentation, signatures, and information for enrollment submissions.
• Maintain enrollment data within credentialing software, payer portals, and databases, ensuring information integrity and accuracy.
• Serve as the primary point of contact for payers to resolve enrollment issues, clarify requirements, and expedite application processing.
• Work closely with revenue cycle teams to identify and address claim denials or delays caused by credentialing or enrollment gaps.
• Ensure all credentialing and enrollment activities comply with federal, state, and payer-specific regulations and health system policies.
• Regularly monitor payer portals, correspondence, and notifications for status updates and take prompt action to maintain active participation. 
• Generate reports and summaries for leadership to track enrollment performance, identify trends, and highlight opportunities for improvement.
• Collaborate with managed care and reimbursement leadership to streamline and enhance credentialing and enrollment processes for greater efficiency and accuracy.

Qualifications:

• Associate's degree in business, Health Administration, or another discipline that provides applicable experience (required)
• Bachelors degree in business, Health Administration, or another discipline that provides applicable experience (preferred)
• 1+ years' experience in healthcare environment dealing with reimbursement (required)
• Prefer managed care/reimbursement experience of at least three (3) years (preferred)

Work Setup: Onsite (first 3 months then will transition to hybrid)
Schedule: Night Shift, 9:00 PM-6:00 AM
Location: BGC, Taguig City



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