Credentialing Specialist - Professional

Category

Business Operations

Position Type

Full-Time

At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it.

As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities.

Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.

If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you.

For more information about our company, visit CuranaHealth.com.

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.

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