Credentialing Specialist

🔥 14 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 • Review applications for completeness • Conduct, maintain, and analyze Primary Source Verifications (PSV) • Investigate and validate discrepancies and adverse information • Communicate with healthcare practitioners to clarify questions and obtain missing information • Follow up on application requests and outstanding PSVs • Maintain accurate and complete credentialing software database records • Communicate with internal and external customers to obtain or provide information • Compile, evaluate, and present practitioner-specific data to the Credentials Committee • Create and send approval, information-request, and termination notices based on Credentials Committee decisions • Request recredentialing applications from practitioners and organizational providers • Collaborate with contacts to process or terminate recredentialing applicants timely • Monitor provider expirables, including licenses, DEA, and malpractice insurance • Review federal/state 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, and 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)

🏖️ Benefits

• Equal Employment Opportunity commitment and nondiscrimination policy • No visa sponsorship is available at this time