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 – Credentials Committee 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 assisting with the coordination 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 of practitioner information.
Duties to include any combination of the following:
- Maintain confidentiality regarding legal matters, privacy issues, information technology and data integrity
- Maintains credentialing software database by ensuring that data entered is complete and accurate
- Collect, analyze, and present provider-specific data for bi-monthly review by the Credentials Committee
- Track inbound and outbound communication on behalf of the Medical Directors to providers
- Communicate with health care practitioners to clarify questions and request any missing information
- Communicate with internal and external customers in a clear, concise manner to obtain or provide necessary information
- Draft and distribute formal approval letters, requests for additional information, and termination notices to practitioners in accordance with decisions made by the Credentials Committee
- Compile and summarize provider responses to requests for additional information, ensuring clarity and accuracy for review and documentation purposes
- Coordinate the preparation of the bi-monthly Credentials Committee agenda and accurately record and maintain official meeting minutes
- Review and process assigned NPDB Continuous Query reports, ensuring timely and appropriate action is taken
Skills & Requirements
- High school diploma required; Associate degree preferred
- 2-5 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).
