Credentialing Specialist - Facility

Curana Health; United States; Remote; USD 40,000 - 60,000; Full time

Job summary

A leading company in value-based primary care is seeking a Credentialing Specialist to ensure compliance and safeguard member safety within its provider network. This role involves evaluating credentialing applications, maintaining data systems, and collaborating with various teams. Candidates should have strong attention to detail, communication skills, and proficiency in Microsoft Office.

Qualifications

• High school diploma required; additional certification in healthcare credentialing is a plus.
• Prior experience in credentialing preferred, but not required.
• Proficient in Microsoft Excel and Word.

Responsibilities

• Evaluate facility credentialing applications for accuracy and completeness.
• Engage with facilities to clarify credentialing-related questions.
• Monitor facilities' expiration dates for licenses and documentation.

Skills

Attention to detail

Communication skills

Confidentiality

Team-oriented

Education

High school diploma

Tools

Microsoft Excel

Microsoft Word

Credentialing databases

Job description

Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 34 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Summary

The Credentialing Specialist for Facilities ensures that the health plan’s provider network includes facilities that meet regulatory standards. This position plays a crucial role in ensuring compliance, safeguarding member safety, and minimizing liability for the company.

Essential Duties & Responsibilities

Credentialing Review & Evaluation: Evaluate facility credentialing applications for accuracy and completeness based on specialty requirements. Obtain the necessary verifications and ensure compliance with regulatory standards.

Communication: Engage with facilities to clarify credentialing-related questions and obtain missing information to complete their application.

Data Entry & Management: Update and maintain credentialing software systems with necessary facility information. Perform data corrections and ensure all files are complete and up to date.

Recredentialing & Follow-Up: Request and follow up on recredentialing applications, ensuring timely processing and compliance with internal guidelines.

Monitoring & Compliance: Regularly monitor facilities' expiration dates for licenses, DEA certificates, and other relevant documentation. Present summary reports to the Credentialing Committee monthly.

Sanctions & Exclusions Review: Review federal and state sanctions/exclusions reports to ensure facilities comply with regulations.

Reporting & Documentation: Generate and distribute credentialing reports to internal teams. Prepare and send formal notices of approval, requests for additional information, and termination notices as required by the Credentialing Committee.

Support & Collaboration: Assist the contracting department with credentialing support and provide ongoing status updates on facilities' credentialing status.

Qualifications

Skills & Requirements

Education: High school diploma required; additional certification or experience in healthcare credentialing is a plus.

Experience: Prior experience in credentialing or related field preferred, but not required.

Skills:

• Proficient in Microsoft Excel and Word; familiarity with credentialing databases is a plus.
• Strong attention to detail and ability to maintain confidentiality.
• Flexible, team-oriented, and capable of working with minimal supervision.
• Strong verbal and written communication skills.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).