Credentialing Specialist
Blank StreetSalary not specified
Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- Any graduate or post-graduate degree
- Minimum 3 years of experience in U.S. Healthcare system, provider and facility Credentialing
- At least 2 years of experience in a supervisory or leadership role
- Knowledge of CAQH
- Familiarity with NCQA, Joint Commission, and other regulatory requirements
- Strong organizational, communication, and problem-solving skills
- Knowledge of Microsoft Office and Google applications (Google Doc, Spreadsheets, Forms, Calendar)
- A strong track record of juggling multiple initiatives and clear ability to prioritize
Responsibilities
- Supervise and manage the Credentialing team, including hiring, training, performance evaluations, and scheduling
- Manage a team responsible for hitting daily and weekly targets, driving improved performance in file processing amid growing volume
- Focus on growth paths and success of direct reports (Operations Associates), emphasizing individual and team metrics
- Hold weekly 1:1 meetings with Operations Associates to review file quality, throughput, blockers, improvement ideas, and professional development; coach lower and middle performers
- During performance reviews, coordinate with leadership on ratings and deliver review conversations for team members
- Host daily standups to cover previous day’s performance, current day’s plan, and weekly performance reviews
- Ensure timely and accurate credentialing and re-credentialing of healthcare providers
- Maintain and update the credentialing database and provider files
- Monitor compliance with regulatory requirements and accreditation standards (e.g., NCQA, Joint Commission)
- Develop and implement credentialing policies and procedures
- Serve as a resource and point of contact for credentialing-related inquiries
- Prepare reports and present credentialing metrics to leadership
- Collaborate with other departments, such as Human Resources and Compliance, on credentialing matters
- Stay current on industry trends and changes in credentialing regulations
- Onboard new hires, educate and support new team members during training, and participate in hiring new Operations Associates
Skills
Credentialing
Re-credentialing
NCQA
Joint Commission
Regulatory Compliance
Team Management
Performance Metrics
Database Management
Hiring
Training
Performance Reviews
Assured
Digital solutions for insurance claims processing
About Assured
Assured.Claims provides digital solutions specifically for Property and Casualty (P&C) insurance carriers, focusing on enhancing the claims process. Their platform allows insurers to manage claims digitally, utilizing a combination of artificial intelligence and human interaction to facilitate effective communication with all parties involved. A key feature of their service is the First Notice of Loss (FNOL) web app, which helps insurers collect structured data at the beginning of a claim, leading to improved customer experiences and faster claim resolutions. Assured.Claims differentiates itself by offering a white-label solution, enabling insurers to implement their technology under their own brand without needing to develop it themselves. The company's goal is to streamline the claims process for insurers, ultimately improving efficiency and accuracy in claims handling.
Palo Alto, CaliforniaHeadquarters
2019Year Founded
$4.3MTotal Funding
SEEDCompany Stage
Fintech, AI & Machine LearningIndustries
51-200Employees