Credentialing Specialist

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Curana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🤝 B2B

⚕️ Healthcare Insurance

Healthcare • B2B • Healthcare Insurance

Curana Health is a healthcare provider focused on senior primary care and on-site clinical services in skilled nursing and senior living communities. The company partners with operators, payors, and Medicare Advantage plans to implement value-based care models, offering physician-led care teams, medical director services, care coordination (including RPM and APCM), behavioral health, and palliative care. Curana emphasizes reducing hospital readmissions, falls, and polypharmacy while improving resident satisfaction through integrated, community-based care supported by technology and payor partnerships.

📋 Description

• Perform data entry, data collection, and verification of practitioner credentials from primary sources • Analyze collected information according to Curana Health policies and procedures • Maintain confidentiality of practitioner information, legal matters, privacy issues, information technology, and data integrity • Review practitioner applications for completeness • Conduct, maintain, and analyze Primary Source Verifications while meeting production goals • Investigate and validate discrepancies and adverse information • Communicate with healthcare practitioners to clarify questions and request missing information • Follow up on application requests and outstanding Primary Source Verifications • Maintain the credentialing software database with complete and accurate data • Communicate with internal and external customers to obtain or provide necessary information • Compile, evaluate, and present practitioner-specific data for Credentials Committee review • Create and send approval, information request, and termination notices based on Credentials Committee decisions • Request recredentialing applications from practitioners and organizational providers • Collaborate with internal and external contacts to process or terminate recredentialing applicants timely • Monitor provider expirables including licenses, DEA, and malpractice insurance • Review federal/state and license sanctions and exclusions reports • Review NPDB Continuous Query reports and take appropriate action • Assist with Delegation Oversight audit reviews, tracking, and reporting

🎯 Requirements

• High school diploma required; Associate degree preferred • 1-4 years of hospital or insurance plan credentialing experience • Working knowledge of Joint Commission, NCQA, URAC, HFAP standards • Certified Provider Credentialing Specialist (CPCS) preferred • Must be able to work in the US; the company is unable to provide visa sponsorship (H1B or otherwise)