Credentialing Specialist: Provider Verification & Compliance

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

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.