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 than1,500 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 - Committee Coordinator 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. This role includes managing committee responsibilities, such as handling communications, documentation, and meetings. Maintains a high level of confidentiality for provider information.

Duties to include any combination of the following:

• Manage sensitive high-level committee communications on behalf of Medical Directors (MDs) to providers, ensuring confidentiality.
• Track inbound and outbound communications and documentation for audit and reporting purposes.
• Manage written communications, including emails, between MDs and providers, and communicate by phone (as needed) on behalf of the Medical Directors to clarify and confirm messages.
• Ensure timely and accurate distribution of communications within required timelines.
• Summarize and present provider records to the Credentialing Committee twice a month.
• Create and send formal approvals, requests for information, and termination notices to providers based on Credentialing Committee decisions.
• Provide status updates and follow-ups on communications as needed.
• Collaborate with internal and external contacts to ensure seamless communication flow between the board, MDs, and providers.
• Attend committee meetings twice a month and present relevant information as needed.
• Evaluate credentialing applications (Standard CAQH and State Specific Applications) for accuracy, completeness, and recent updates, obtaining 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 required information.
• Conduct ongoing monitoring of provider expirables, such as licenses and DEA certificates.
• Review and process assigned federal/state license sanctions and exclusion reports to determine if providers have sanctions/exclusions.
• Review and process assigned NPDB Continuous Query reports, taking appropriate action when new reports are found.
• Provide data for quarterly credentialing reports for the Quality Improvement Committee.

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.