Credentialing and Licensure Specialist

Job Description

Job Description

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Credentialing and Licensure Specialist will join the Upward Health Business Services team to assist in a range of activities with the team. There will be primary focus on assisting our Credentialing and Licensure Supervisor with nursing and provider licensure efforts and associated credentialing efforts. The role will also participate in payer audit needs when/if needed. position requires attention to detail, strong organizational skills, and the ability to manage a dynamic workload. This role reports to the Credentialing and Licensure Supervisor.

Skills Required:

• Proven background in credentialing, with experience handling both individual and group credentialing applications.
• Ability to create and maintain databases for credentialing approvals and processes with reporting across multiple internal teams.
• Understanding of medical record reviews and chart audits, and an ability to navigate EHRs
• Understanding of the healthcare industry, particularly in working with health insurance companies, healthcare provider organizations, or other healthcare services companies.
• Ability to manage complex processes and maintain accuracy across multiple provider records.
• Strong verbal and written communication skills to collaborate effectively with internal teams and external stakeholders.
• Ability to prioritize tasks and manage competing deadlines in a fast-paced, goal-oriented environment.
• Comfort with using various software programs, including Microsoft Office, Jira, and clinical applications (EHR, care management systems).
• Demonstrated ability to adjust to evolving priorities and workload demands in a virtual, dynamic environment.

Key Behaviors:

Accountability:

• Takes ownership of the credentialing process, ensuring all tasks are completed in a timely and efficient manner.

Collaboration:

• Works well with cross-functional teams, maintaining open communication and contributing to a positive, supportive work environment.

Attention to Detail:

• Demonstrates exceptional focus on detail, ensuring that all submissions and approvals are accurate and tracked.

Flexibility:

• Adapts quickly to changing processes, priorities, and workload, managing multiple responsibilities without compromising quality.

Professionalism:

• Maintains a professional approach with both internal and external stakeholders, exemplifying Upward Health's values at all times.

Competencies:

Problem-Solving:

• Capable of identifying issues and developing solutions independently while managing the complexities of the credentialing process.

Organization:

• Effectively manages multiple tasks, timelines, and deadlines while keeping records organized and up-to-date.

Communication:

• Clearly communicates processes, updates, and issues with both team members and external parties.

Customer Focus:

• Demonstrates a strong commitment to understanding and meeting the needs of both internal teams and external health plan representatives.

Leadership:

• Though not a supervisory position, exhibits leadership qualities by driving efficiency, offering guidance, and ensuring team alignment on goals.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

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