Credentialing Specialist - Professional

Curana Health; United States; On-site; USD 52,000 - 72,000; Full time

Job summary

Curana Health is seeking a Credentialing Specialist to manage practitioner credentialing and recredentialing processes. You will verify credentials against primary sources, maintain confidential records, and support the Credentials Committee with accurate data and timely information.

Applicants should have 1–4 years of credentialing experience in hospital or health plan settings, knowledge of Joint Commission/NCQA standards, and a CPCS certification preferred.

Qualifications

• 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 (certification)

Responsibilities

• Maintain confidentiality of practitioner information.
• Review applications for completeness and accuracy.
• Perform Primary Source Verifications (PSV) per policy.
• Investigate discrepancies and verify information from applications and PSVs.
• Communicate with health care practitioners to obtain missing information.
• Follow up on credentialing requests to meet production goals.
• Maintain credentialing software database with accurate data.
• Interact with internal and external customers clearly and concisely.
• Prepare practitioner data for Credentials Committee review.
• Draft approvals and notices based on Credentials Committee decisions.
• Request recredentialing applications from practitioners and providers.
• Collaborate with internal/external contacts to ensure timely processing.
• Monitor licenses, DEA, and malpractice insurance expirables.
• Review sanctions/exclusions reports and NPDB queries.
• Assist with Delegation Oversight audits and reporting.

Skills

Credentialing experience

Healthcare standards knowledge

Attention to detail

Regulatory compliance awareness

Education

High school diploma

Associate degree preferred

CPCS certification preferred

Job description

At Curana Health, we're on a mission to radically improve the health, happiness, and dignity of older adults—and we're looking for passionate people to help us do it.

As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities.

Founded in 2021, we've grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.

Ranked #147 on the Inc. 5000 list of America's fastest-growing private companies, we're just getting started. If you're looking to make a meaningful impact on the senior healthcare landscape, you're in the right place—and we look forward to working with you.

Summary

For more information about our company, visit CuranaHealth.com.

Under general supervision, the Credentialing Specialist is responsible for all functions relating to the credentialing and recredentialing of practitioner applicants. Thus, ensuring the plan provider network consists of practitioners that meet the regulatory criteria to minimize liability to the company and to maximize safety for members.

Essential Duties & Responsibilities

Responsibilities include data entry, data collection, verification of credentials from primary source and analyzes information collected according to Curana Health policies and procedures. Maintains a high level of confidentiality of practitioner information.

Duties To Include Any Combination Of The Following

• 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
• Recognize 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 assigned NPDB Continuous Query reports and takes appropriate action when new reports are found
• Assists with Delegation Oversight audit reviews, tracking and reporting.

Qualifications

Skills & 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