Execute credentialing and enrollment workflows for new providers.
Maintain accurate provider and practice data in credentialing database.
Complete Medicare revalidations, Medicaid recredentialing, and commercial recredentialing per payer schedules.
Integrated Dermatology is a leading national dermatology practice that acquires and partners with dermatology practices across the United States. The culture at ID is filled with hard-working, dynamic individuals who come together to ensure the success of our partner dermatologists.
Manage the credentialing and re-credentialing processes for physicians, nurses, and allied health professionals.
Verify licenses, certifications, education, training, and work history to ensure providers are fully qualified.
Maintain accurate and complete credentialing files, ensuring all staff are cleared before providing care.
Curana Health focuses on improving the health, happiness, and dignity of older adults. They are a national leader in value-based care, with over 1,000 clinicians serving 200,000+ seniors across 32 states.
Ensure timely resolution and completion of payer enrollment.
Streamline processes and workflows for the onboarding department.
Work with internal and external stakeholders to resolve complex provider enrollment issues.
Privia Health collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology.
Promptly and accurately record all provider information.
Monitor status of payer applications to ensure completion.
Initiate and follow through on all aspects of provider credentialing.
UnityPoint Health is committed to team members and is recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. They champion a culture of belonging where everyone feels valued and respected, and provide employees with support and development opportunities.
Enroll and revalidate doctors and facilities with payors.
Process applications for licensing, permits, certifications, insurances, and relevant credentialing documents.
Review incoming insurance correspondence and mail and maintain and update credentialing spreadsheets accordingly.
CHOICE is the largest provider of pediatric dental care in the Southwest United States. They pride themselves on delivering high quality care to children in their communities.
Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
Works with both internal and external stakeholders to resolve complex provider credentialing issues.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers
Evaluate facility credentialing applications for accuracy and completeness.
Engage with facilities to clarify credentialing-related questions and obtain missing information.
Update and maintain credentialing software systems with necessary facility information.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a national leader in value-based care, serving 200,000+ seniors in 1,500+ communities across 32 states, with a team of more than 1,000 clinicians and professionals.
Provides non-clinical administrative support to Case Managers and Care Coordinators.
Obtains and manages medical documents, ensuring accurate record retrieval.
Prioritizes tasks based on expedited requests with attention to detail.
Spectrum Healthcare Resources (SHR) delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. They provide physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies.
Own the day-to-day tracking and progress of clinician credentialing and payer enrollment workflows.
Identify and resolve blockers across credentialing, enrollment, and re-credentialing processes.
Support clinicians directly by guiding them through credentialing and enrollment requirements.
Wheel is evolving the traditional care ecosystem by equipping companies with a premier platform to deliver virtual care at scale. They offer strategies and technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.
Manage Medicare and Medicaid enrollment activities.
Oversee state-level entity enrollment for all jurisdictions.
Manage the vendor contract workflow.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers; through their leading-edge care model they are shaping the future of community-based palliative care nationwide.
Track and manage prior authorization requests, renewals, and extensions.
Verify member eligibility and benefits to confirm coverage requirements.
Upload, organize, and maintain member records and clinical documentation accurately and timely.
Leap is a benefits solution company focused on reshaping how life-changing therapies are delivered and financed. They are a fast-growing company that partners with Fortune 500 companies and leading TPAs, focusing on lower costs, improved access, and better care.
Monitor incoming faxes for authorization requests, enter UM authorizations review requests, and verify eligibility and claims history.
Ensure all necessary documentation is submitted, contact providers for required medical records, and generate correspondence for notifications.
Initiate appeal cases, meet deadlines, assist UM Nurses, and handle inquiries from call centers and other sources.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly and fairly. While the company size is not mentioned, they seem to have a modern approach by utilizing AI tools in the hiring process to identify top-fitting candidates for their client companies.
Play an active role in patient registration and enrollment, including organizing community engagement and outbound calls to patients.
Engage with a panel of assigned patients to provide care navigation, appointment logistics, prescription drug support, lab support, referral coordination, care plan adherence, and resource sharing.
Participate in community events to support patient activation and trust-building, including relationship-building with key contacts, facilitating group education sessions, and liaising with community organizations.
Zócalo Health is a tech-driven healthcare provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared experiences. Founded in 2021, they are backed by leading healthcare and social impact investors, aiming to improve the lives of communities with culturally competent primary care, behavioral health, and social services.
Lead the oversight of all delegated activities to ensure compliance with CMS, and NCQA requirements.
Serve as the subject matter expert in interpreting compliance and regulatory requirements.
Direct pre-delegation audits, annual audits, required reporting and ongoing oversight of delegates.
Hackensack Meridian Health helps patients live better, healthier lives, and helps team members succeed. They have a culture rooted in connection and collaboration, and employees are considered team members. They are advancing their mission to transform healthcare and serve as a leader of positive change.