[Hiring] Credentialing Specialist @Curana Health, Inc.

Role Description

The Credentialing Specialist for Facilities ensures that the health plan’s provider network includes facilities that meet applicable credentialing and regulatory standards. This position plays an important role in maintaining compliance, protecting member safety, and minimizing organizational risk and liability.

Essential Duties & Responsibilities

• Credentialing Review & Evaluation:
  • Review facility credentialing applications for accuracy and completeness based on applicable facility and specialty requirements.
  • Complete primary source verification and other required reviews, including:
    • License verification
    • CMS Certification Number (CCN) verification
    • DEA verification
    • National Practitioner Data Bank (NPDB) reviews
    • Accreditation reviews
    • Additional facility credentialing requirements
• Communication:
  • Communicate with facilities to clarify credentialing questions, resolve discrepancies, and obtain missing information needed to complete their applications.
• Data Entry & Management:
  • Enter, update, and maintain accurate facility information within credentialing systems.
  • Correct data as needed and ensure credentialing records are complete, accurate, and up to date.
• Recredentialing & Follow-Up:
  • Request and follow up on facility recredentialing applications, ensuring they are completed and processed within established timelines and internal guidelines.
• Monitoring & Compliance:
  • Monitor the expiration dates of facility licenses, DEA certificates, accreditations, and other required documentation.
  • Ensure facilities continue to meet applicable regulatory, compliance, and health plan credentialing standards.
  • Prepare and present monthly summary reports to the Credentialing Committee.
• Sanctions & Exclusions Review:
  • Review applicable federal and state sanctions and exclusions reports to verify that facilities remain compliant with credentialing and regulatory requirements.
• Reporting & Documentation:
  • Generate and distribute credentialing reports to internal teams.
  • Prepare and send formal approval notices, requests for additional information, and termination notices as directed by the Credentialing Committee.
• Support & Collaboration:
  • Provide credentialing support to the contracting department and communicate ongoing updates regarding each facility’s credentialing status.
• Workload & Productivity:
  • Manage a high-volume workload while meeting established production expectations.
  • Prioritize multiple assignments, maintain accuracy, and complete credentialing activities within required timelines.

Qualifications

• High school diploma or equivalent required.
• Previous facility credentialing experience is preferred, particularly experience supporting health plan credentialing requirements.
• Experience reviewing accreditation, regulatory, and compliance requirements for healthcare facilities is preferred.
• Familiarity with NCQA, CMS, or other health plan credentialing standards is preferred.
• Additional healthcare credentialing experience or certification is a plus.

Requirements

• Strong attention to detail and the ability to maintain accuracy while managing a high-volume workload.
• Familiarity with facility credentialing concepts and primary source verification processes, including license, CCN, DEA, NPDB, accreditation, and other required facility reviews.
• Strong organizational and time-management skills.
• Ability to manage multiple priorities and meet production expectations in a fast-paced environment.
• Tech-savvy and comfortable learning new systems and technology quickly.
• Proficiency in Microsoft Excel and Word.
• Ability to work independently and remain focused and productive in a remote environment.
• Strong verbal and written communication skills.
• Ability to handle confidential information appropriately.
• Flexible, collaborative, and comfortable working with minimal supervision.
• Comfortable working across multiple screens, databases, and systems throughout the day.
• Previous facility credentialing experience, preferably within a health plan environment preferred.
• Experience with facility accreditation, regulatory, and compliance reviews preferred.
• Knowledge of NCQA, CMS, and health plan credentialing standards preferred.
• Experience using credentialing databases or software platforms preferred.

Remote Work Requirements

• This is a remote position. Candidates must have a dedicated, professional workspace that is free from distractions and background noise.
• Employees will regularly be on camera for meetings, training sessions, and team collaboration and must be able to maintain focus, professionalism, and productivity while working remotely.
• The company provides necessary equipment, including dual monitors.
• Candidates should be comfortable using multiple monitors and navigating between several systems as part of their daily responsibilities.
• Training will be provided on the company’s credentialing platform.
• Experience with the specific system is not required, but candidates must be able to learn new technology quickly.
• A basic understanding of facility credentialing and primary source verification processes is strongly preferred.