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 33 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 health care system. Our mission: To radically improve the health, happiness and dignity of senior living residents.
Job Summary
The Credentialing Specialist ensures that the plan provider network consists of providers that meet the regulatory criteria to minimize liability to the company and to maximize safety for members.
KNOWLEDGE/SKILLS/ABILITIES
Responsible for coordinating assigned aspects of enterprise-wide credentialing process for practitioners and health delivery organizations according to the Curana Health policy and procedures. Maintains a high level of confidentiality for provider information.
Duties to include any combination of the following:
- Evaluate credentialing applications for accuracy and completeness, based on provider specialty, and obtain required verifications per organizational policies while meeting production goals.
- Communicate with healthcare providers to clarify questions and request missing information.
- Update credentialing software systems with necessary information.
- Request and follow up on recredentialing applications from physician and organizational providers, adhering to department guidelines and production goals.
- Collaborate with internal and external contacts to ensure timely processing or termination of recredentialing applicants.
- Complete data corrections in the credentialing database for processing recredentialing applications.
- Review claims payment and provider data management systems to determine provider status as needed.
- Conduct ongoing monitoring of provider expirables, such as licenses and DEA certificates, and summarize provider records for monthly presentation to the Credentialing Committee.
- Review and process assigned federal/state license sanctions and exclusions reports to assess provider sanctions/exclusions.
- Review and process assigned NPDB Continuous Query reports, taking appropriate action on new findings.
- Contribute to quarterly credentialing reports for the Quality Improvement Committee.
- Transfer physician credentialing applications to the CVO for processing.
- Distribute weekly recredentialing reports to the contracting department and notify of upcoming provider terminations.
- Create and send formal approvals, requests for information, and termination notices to providers based on Credentialing Committee decisions.
- Assist with Delegation Oversight audit reviews, tracking, and reporting.
- Provide credentialing support and ongoing status updates to the contracting department.
Skills & Requirements
- High school diploma or equivalent
- College Degree Preferred
- Credential Specialist Certification Preferred
- Must be proficient with a variety of relevant computer programs and have excellent attention to detail.
- Knowledge of medical credentialing and privileging procedures and standards
- Excellent verbal and written communication skills
- Proficient in Microsoft Office Word and Excel
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.
