USASenior Credentialer
2 нед. назад
85k–95k USD / yearUSASeniorOnsite
Manage and oversee clinical credentialing operations ensuring healthcare providers meet all credentialing and compliance requirements.
О компании
- blends the power of analytics with a compassionate approach to care. As a leading healthcare IT and services platform, we focus on care and coverage coordination to improve outcomes and member experiences. We deliver not only information but understanding and peace of mind for your members. Guided by robust AI, 's Care Guide Teams help members navigate the healthcare system with empathy, ensuring they receive the right support tailored to their unique needs. Our expert clinicians provide in-home assessments, including lab and diagnostic testing, to close care gaps and improve quality, cost, and overall member well-being.
Обязанности
- • Own and manage the full lifecycle of clinical credentialing for ’s clinical workforce.
- • Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, and other required credentials.
- • Conduct primary source verification and maintain accurate, complete, and audit-ready provider credentialing files.
- • Manage credentialing requirements for Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical professionals.
- • Monitor provider licenses, certifications, registrations, malpractice insurance, and other time-sensitive credentials to ensure compliance with applicable requirements.
- • Proactively track expirables and initiate renewal processes well in advance of expiration dates.
- • Identify and resolve credentialing discrepancies, gaps, and compliance issues, escalating concerns when appropriate.
- • Coordinate provider enrollment and credentialing activities with health plans, payers, healthcare organizations, and other external partners as needed.
- • Guide clinical providers through credentialing, onboarding, and related compliance requirements, serving as a knowledgeable resource throughout the process.
- • Partner with Clinical Operations, HR, Compliance, and leadership to ensure providers are appropriately credentialed and cleared before providing patient care.
- • Maintain accurate provider information and credentialing documentation within internal systems and databases.
- • Develop, document, and continuously improve credentialing workflows, processes, checklists, and standard operating procedures.
- • Monitor credentialing timelines and performance metrics to ensure requirements and deadlines are consistently met.
- • Support internal and external audits by maintaining organized, accurate, and readily accessible credentialing documentation.
- • Stay current on applicable healthcare regulations, credentialing standards, payer requirements, and state-specific licensing requirements.
- • Identify opportunities to improve efficiency, reduce credentialing delays, and enhance the overall provider onboarding experience.
- • Serve as a subject-matter expert and resource for clinical credentialing across the organization.
Требования
- • 7+ years of clinical credentialing experience, preferably within a healthcare organization, medical group, health plan, staffing organization, or similar environment.
- • Strong understanding of the provider credentialing and recredentialing lifecycle, including primary source verification and ongoing monitoring.
- • Experience credentialing a variety of healthcare professionals, including Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical providers.
- • Working knowledge of healthcare licensing, certifications, malpractice insurance, professional references, education verification, and other provider qualification requirements.
- • Experience working with payer or health plan credentialing and enrollment processes is strongly preferred.
- • Familiarity with credentialing databases, provider management systems, CAQH, and other healthcare credentialing platforms.
- • Strong understanding of healthcare compliance requirements and the ability to research and interpret credentialing, licensing standards and running system audits.
- • Exceptional attention to detail and accuracy, particularly when working with sensitive provider and compliance information.
- • Strong organizational and time-management skills with the ability to manage multiple providers, deadlines, and priorities simultaneously.
- • Excellent written and verbal communication skills with the ability to effectively communicate with clinicians, internal stakeholders, health plans, and external partners.
- • Demonstrated ability to identify problems, independently research solutions, and proactively resolve credentialing issues.
- • Comfortable working independently while also collaborating closely with Clinical Operations, HR, Compliance, and leadership.
- • Experience developing or improving credentialing processes, workflows, and standard operating procedures is a plus.
Другое
- We are seeking a Senior Clinical Credentialer to take a leading role in managing and overseeing 's clinical credentialing operations. This position will be responsible for ensuring that healthcare providers meet all applicable credentialing, licensing, regulatory, and compliance requirements before and throughout their engagement with .
- The Senior Clinical Credentialer will manage the end-to-end credentialing and recredentialing process for a diverse population of healthcare professionals, including Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical providers as needed. This individual will serve as a subject-matter expert on credentialing requirements, identify potential compliance issues, and work proactively to ensure providers remain fully credentialed and eligible to deliver care.
- In addition to credentialing responsibilities, this role will partner closely with Clinical Operations, Human Resources, Compliance, and other internal teams to support a seamless provider onboarding experience. The Senior Clinical Credentialer will help develop and improve credentialing workflows, maintain accurate provider records, monitor expirables, and ensure documentation is complete, accurate, and audit-ready.
- The ideal candidate is highly organized, self-motivated, and comfortable working independently in a fast-paced healthcare environment. You have strong knowledge of clinical credentialing standards and processes, exceptional attention to detail, and the ability to manage multiple providers and deadlines simultaneously.