Provider Credentialing Specialist: Verification & Compliance

Curana Health; United States; A distancia; USD 52.000 - 70.000; Jornada completa

Descripción de la vacante

Curana Health is seeking a Credentialing Specialist to manage credentialing and recredentialing of practitioners across our network. You will verify credentials from primary sources, maintain confidentiality, and ensure timely processing in line with organizational policies.

Responsibilities include data entry, detailed application reviews, PSV verifications, and collaboration with internal and external contacts to keep the provider network compliant and up-to-date.

Formación

• 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.

Responsabilidades

• Data entry, data collection, verification of credentials from primary source.
• Maintain confidentiality of practitioner information.
• Review applications for completeness and perform verifications.
• Communicate with practitioners to clarify questions and request missing information.
• Maintain credentialing software database and ensure data accuracy.
• Prepare and present practitioner data for Credentials Committee review.
• Send approvals, information requests, or termination notices as needed.
• Monitor provider license, DEA, and malpractice insurance expirables.
• Review sanctions and exclusions reports and NPDB queries as required.
• Assist with Delegation Oversight audit reviews and reporting.

Conocimientos

Data entry

Confidentiality

Communication

Credentialing processes

Compliance knowledge

Educación

High school diploma

Associate degree preferred

Descripción del empleo

Curana Health is seeking a Credentialing Specialist to manage credentialing and recredentialing of practitioners across our network. You will verify credentials from primary sources, maintain confidentiality, and ensure timely processing in line with organizational policies.

Responsibilities include data entry, detailed application reviews, PSV verifications, and collaboration with internal and external contacts to keep the provider network compliant and up-to-date.