Credentialing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute data entry, data collection, and verification of practitioner credentials sourced from primary channels.

• Assess gathered information in accordance with Curana Health's policies and procedures.

• Uphold the confidentiality of practitioner details, legal matters, privacy concerns, information technology, and data integrity.

• Evaluate practitioner applications for completeness and accuracy.

• Conduct, manage, and analyze Primary Source Verifications while achieving production targets.

• Investigate and confirm discrepancies and adverse information.

• Engage with healthcare practitioners to clarify inquiries and request missing details.

• Follow up on application requests and outstanding Primary Source Verifications.

• Maintain the credentialing software database with thorough and precise data.

• Communicate with both internal and external customers to gather or provide essential information.

• Compile, assess, and present practitioner-specific data for the Credentials Committee's review.

• Generate and dispatch approval, information request, and termination notices based on the Credentials Committee's decisions.

• Request recredentialing applications from practitioners and organizational providers.

• Collaborate with internal and external stakeholders to ensure timely processing or termination of recredentialing applicants.

• Monitor provider expirables, including licenses, DEA, and malpractice insurance.

• Review federal/state and license sanctions and exclusions reports.

• Examine NPDB Continuous Query reports and take the necessary actions.

• Assist with Delegation Oversight audit reviews, tracking, and reporting.

⛳️ Requirements

• High school diploma is mandatory; an Associate degree is preferred.

• 1-4 years of experience in hospital or insurance plan credentialing.

• Familiarity with Joint Commission, NCQA, URAC, and HFAP standards.

• Certification as a Provider Credentialing Specialist (CPCS) is preferred.

• Must be eligible to work in the US; the company cannot provide visa sponsorship (H1B or otherwise).

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plan with company match.

• Professional development opportunities.

• Flexible work schedule.

• Paid time off and holidays.