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 34 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 healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Job Summary

Under general supervision, the Credentialing Specialist is responsible for all functions relating to the credentialing and recredentialing of practitioner applicants. Thus, ensuring the plan provider network consists of practitioners that meet the regulatory criteria to minimize liability to the company and to maximize safety for members.

KNOWLEDGE/SKILLS/ABILITIES

Responsibilities include data entry, data collection, verification of credentials from primary source and analyzes information collected according to Curana Health policies and procedures. Maintains a high level of confidentiality of practitioner information.

Duties to include any combination of the following:

• Maintain confidentiality regarding legal matters, privacy issues, information technology and data integrity
• Perform detailed and thorough review of applications for completeness
• Conducts, maintains, and analyzes Primary Source Verifications (PSV) as outlined in the organization policies while meeting production goals
• Recognize potential discrepancies and adverse information, and independently investigate and validate information from applications, primary source verifications, or other sources
• Communicates with health care practitioners to clarify questions and request any missing information
• Conducts follow-up on application requests and outstanding PSVs, following department guidelines and production goals
• Maintains credentialing software database by ensuring that data entered is complete and accurate
• Communicates with internal and external customers in a clear, concise manner to obtain or provide necessary information
• Compile, evaluate, and present the practitioner-specific data collected for review by the Credentials Committee
• Creates and sends formal approval, requests for information and termination notices to practitioners based on Credentials Committee decisions
• Requests recredentialing applications from practitioners and organizational providers
• Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants

• Conducts ongoing monitoring of provider expirables such as license, DEA and malpractice insurance
• Reviews and processes assigned federal/state and license sanctions and exclusions reports to determine if practitioners have sanctions/exclusions
• Reviews and processes assigned NPDB Continuous Query reports and takes appropriate action when new reports are found
• Assists with Delegation Oversight audit reviews, tracking and reporting.

Skills & Requirements

• 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

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.

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).