Credentialing & Compliance Specialist

Curana Health; Idaho; Sur place; USD 42 000 - 70 000; Plein temps

Résumé du poste

Curana Health is seeking a Credentialing Specialist to manage practitioner credentialing and recredentialing within a growing national network of senior care providers. You will verify credentials, ensure regulatory compliance, and support the Credentials Committee to minimize risk and maximize patient safety.

The role requires reviewing applications, maintaining confidentiality, and coordinating with practitioners and internal teams to meet deadlines and quality standards.

Qualifications

• 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.
• High school diploma required; Associate degree preferred.

Responsabilités

• Maintain confidentiality regarding legal matters, privacy issues, information technology and data integrity.
• Perform detailed and thorough review of applications for completeness.
• Conducts, maintains, and analyzes Primary Source Verifications (PSV) as outlined in the organization policies while meeting production goals.
• Recognizes potential discrepancies and adverse information, and independently investigate and validate information from applications, primary source verifications, or other sources.
• Communicates with health care practitioners to clarify questions and request any missing information.
• Conducts follow-up on application requests and outstanding PSVs, following department guidelines and production goals.
• Maintains credentialing software database by ensuring that data entered is complete and accurate.
• Communicates with internal and external customers in a clear, concise manner to obtain or provide necessary information.
• Compile, evaluate, and present the practitioner-specific data collected for review by the Credentials Committee.
• Creates and sends formal approval, requests for information and termination notices to practitioners based on Credentials Committee decisions.
• Requests recredentialing applications from practitioners and organizational providers.
• Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.
• Conducts ongoing monitoring of provider expirables such as license, DEA and malpractice insurance.
• Reviews and processes assigned federal/state and license sanctions and exclusions reports to determine if practitioners have sanctions/exclusions.
• Reviews and processes NPDB Continuous Query reports and takes appropriate action when new reports are found.
• Assists with Delegation Oversight audit reviews, tracking and reporting.

Connaissances

Knowledge of credentialing standards

Attention to detail

Formation

High school diploma

Associate degree preferred

Certified Provider Credentialing Specialist (CPCS) preferred

Outils

Credentialing software

Description du poste

Curana Health is seeking a Credentialing Specialist to manage practitioner credentialing and recredentialing within a growing national network of senior care providers. You will verify credentials, ensure regulatory compliance, and support the Credentials Committee to minimize risk and maximize patient safety.

The role requires reviewing applications, maintaining confidentiality, and coordinating with practitioners and internal teams to meet deadlines and quality standards.