Healthcare Credentialing Specialist: Provider Verification

Curana Health, Inc.; United States; À distance; USD 55 000 - 75 000; Plein temps

Résumé du poste

Curana Health, Inc. seeks a Credentialing Specialist to manage credentialing and recredentialing of practitioners across our nationwide health plan network. You will verify credentials, maintain data integrity, and support the Credentials Committee to uphold regulatory and company standards.

In this role you will communicate with practitioners, monitor expirables such as licenses and DEA, and ensure timely processing of primary source verifications and recredentialing requests.

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.

Responsabilités

• Data entry and verification of practitioner credentials.
• Maintain confidentiality of credentialing information and data.
• Review and analyze Primary Source Verifications (PSV) per policy and production goals.
• Communicate with practitioners to obtain missing information and clarify questions.
• Coordinate with Credentials Committee to evaluate and approve/reject credentialing decisions.
• Monitor provider expirables (license, DEA, malpractice insurance).
• Review sanctions/exclusions reports and NPDB queries; take necessary actions.
• Assist with audits and retention/reporting activities.

Connaissances

Credentialing experience

Communication skills

Attention to detail

Formation

High school diploma

Associate degree preferred

Description du poste

Curana Health, Inc. seeks a Credentialing Specialist to manage credentialing and recredentialing of practitioners across our nationwide health plan network. You will verify credentials, maintain data integrity, and support the Credentials Committee to uphold regulatory and company standards.

In this role you will communicate with practitioners, monitor expirables such as licenses and DEA, and ensure timely processing of primary source verifications and recredentialing requests.