Credentialing Specialist

About OpenLoop

OpenLoop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring care anywhere. Our telehealth support solutions are thoughtfully designed to streamline and simplify go-to-market care delivery for companies offering meaningful virtual support to patients across an expansive array of specialties, in all 50 states.

About the Role

OpenLoop's mission is to bring care anywhere by powering telehealth solutions at scale. The Credentialing Specialist is responsible for managing the credentialing and recredentialing processes for healthcare providers in accordance with our NCQA accredited Credentialing Verification Organization (CVO) guidelines. This role ensures all providers meet necessary qualifications and maintain compliance with industry standards, supporting the delivery of high-quality patient care.

What You'll Do

Review and complete initial and renewal credentialing applications for healthcare providers across multiple practices, ensuring adherence to State, Federal, and NCQA CVO guidelines.

• Verify provider credentials, including education, training, licensure, certifications, and work history.
• Maintain and update credentialing documentation in the company's credentialing database while ensuring records are accurate, complete, and up-to-date.
• Monitor the status of credentialing applications and provider files, ensuring timely renewals and proactive follow-ups.
• Track key credentialing metrics and generate reports on credentialing statuses and compliance.
• Serve as a point of contact for providers regarding credentialing inquiries and communicate effectively with regulatory agencies and internal stakeholders.
• Ensure all credentialing activities comply with state/federal regulations, board requirements, and NCQA standards.
• Collaborate with legal and regulatory teams to stay informed about changes in requirements and implement necessary adjustments.
• Identify and resolve issues or discrepancies in credentialing documents and manage communications with accrediting bodies for escalated issues.
• Proactively identify opportunities to enhance the credentialing process and stay updated on industry trends.
• Assist with preparing reports and presentations related to credentialing activities.
• Other duties as assigned.

Who You Are

• 1-2 years of experience in healthcare credentialing, regulatory compliance, or a related field.
• Experience with provider data management systems such as MDStaff.
• Familiarity with NCQA CVO guidelines and multi-state credentialing processes is highly desirable.
• Proficiency in using credentialing software and E-Ticketing systems (e.g., Jira, Zoho Desk) is a plus.
• Detail-oriented with strong organizational and time-management skills.
• Excellent communication skills, both written and verbal, for effective interaction with providers and regulatory bodies.
• Strong analytical and problem-solving abilities.
• Ability to work independently and collaboratively within a team environment.
• Commitment to maintaining confidentiality and adhering to ethical standards in handling provider information.

Preferred Qualifications

• Certification in Credentialing (e.g., Certified Provider Credentialing Specialist) is advantageous.
• Experience working within an NCQA-accredited CVO or similar credentialing organization.

Our Benefits

In addition, for salaried positions you would also be eligible for:

• Medical, Dental, and Vision plans
• Flexible Spending/Health Savings Accounts
• Flexible PTO
• 401(k) + Company Match
• Life Insurance, Pet insurance, and more

Our Company

We have a relatively flat organizational structure here at OpenLoop. Everyone is encouraged to bring ideas to the table and make things happen. This fits in well with our core values of Autonomy, Competence and Belonging, as we want everyone to feel empowered and supported to do their best work.

Sound like a good fit? We'd love to meet you.