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.
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
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.
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.
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.
Own the eligibility and enrollment product area: ingestion, validation, enrollment lifecycle, payer data integrations, and cross-platform eligibility signals
Build and improve the tools, campaigns, and workflows that drive member activation and engagement — not just data plumbing, but the experiences that turn eligibility into impact
Partner with engineering, operations, payer partnerships, and marketing to deliver compliant, resilient, and extensible solutions
Maven is the world's largest virtual clinic for women and families on a mission to make healthcare work for all. More than 2,000 employers and health plans trust Maven's end-to-end platform to improve clinical outcomes and reduce healthcare costs. Maven has an award-winning culture.
Auditing to ensure new provider and care center information is accurate.
Conducting Care Center audits based on the number of providers.
Identifying, monitoring, and managing denial management trends.
Privia Health is a technology-driven, national physician enablement company. They collaborate with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. Their platform is led by industry talent and cloud-based technology.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
Processes acute and post-acute inpatient medical and select intensive outpatient higher level of care requests through clinical review.
Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies to requests.
Collaborates with UM department staff and Medical Directors to make a final determination, and with Care Management staff on discharge planning.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. At Capital, employees work alongside a caring team of supportive colleagues and are encouraged to volunteer in their community.
Seamlessly transition clinicians from the credentialing phase into their active onboarding and training workflows.
Guide clinicians through a structured 30/60/90-day success roadmap, ensuring they hit specific productivity and quality milestones.
Constantly audit the onboarding funnel to identify and remove bottlenecks, reducing the "time-to-activation" for new providers.
Wheel Medical Group is a physician-owned professional corporation that serves patients across the United States, evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. They offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.