Credentialing Specialist

Job Description

Job Description

Credentialing Specialist
Full Time - Exempt
Columbus, OH

AndHealth is a healthcare technology company created to radically improve access and outcomes to specialty care. We are driven by the goal of making world-class specialty care accessible and affordable to all. We partner with health systems, community health centers, plans, and employers to remove barriers to care to ensure all people have access to the care they deserve.

We are seeking a dedicated Credentialing Specialist who can play a key role in the payer enrollment and credentialing processes for all AndHealth licensed and certified healthcare professionals. This role will collaborate with internal teams and external partners to ensure compliance and uphold the highest standards of quality and patient safety. 

Key Deliverables:

• Ensure timely and accurate submission of payer enrollment and credentialing applications and packets. 
• Provide comprehensive support for credentialing activities, including tracking and reporting.
• Maintain strong communication with payers and partners to facilitate enrollment and compliance.

What you’ll do in the role:

• Lead payer enrollment activities for AndHealth’s partners, ensuring timely and accurate submission of all payer enrollment documents to partners.
• Accurately input and track payer enrollment statues for all partners, maintaining comprehensive records for all activities.
• Prepare and distribute reports on enrollment status and credentialing activities for internal use and external audits.
• Establish and maintain effective communication with payer representatives and AndHealth’s partners to resolve any issues related to enrollment and credentialing.
• Create and maintain internal guides outlining payer enrollment processes and best practices.
• Gain an in-depth understanding of the payer landscape in states where we are doing business, with an emphasis on Medicaid and the broader payer mix.
• Support ongoing education and training of AndHealth staff regarding payer enrollment requirements, processes, and landscapes in states where we are doing business.
• Maintain a highly organized system, inclusive of tracking mechanisms, for credentialing schedules, files, and documentation.
• Provide periodic updates to Credentialing Lead and respective AndHealth teams on credentialing and payer enrollment statuses. 
• Assist the Credentialing Lead in all credentialing-related activities for partners, including primary source verifications, license renewals, CAQH profile updates, and preparation of credentialing and re-credentialing applications for AndHealth providers, clinical pharmacists, pharmacy team members and other non-clinical staff.
• Maintain knowledge of current partners, government agencies, and general requirements for credentialing AndHealth professionals. 
• Collaborate with legal and compliance to ensure adherence to relevant laws, regulations, and contractual obligations related to credentialing, licensure and payer enrollment.
• Participate in internal partner related meetings and discussions, providing appropriate and timely responses to payer enrollment processes and timelines. 
• Participate in external partner meetings to obtain updates on payer enrollment related activities.
• Assist with special projects as needed. 

Education & Licensure Requirements:

• Bachelor’s degree is preferred.

Other Skills or Qualifications:

• 2+ years of experience credentialing in healthcare credentialing, payer enrollment or experience working in a healthcare-related role. 
• Experience with credentialing under FQHC and HRSA standards is a plus. 
• You subscribe to and are willing to live our culture creator values.
• Impeccable attention to detail and are attentive and present in your work. 
• Ability to thrive on change and can quickly adapt to evolving processes to continuously improve credentialing. 
• Organized and ability to prioritize work based on changing and challenging deadlines. 
• Self-directed and able to work independently, as well as participate in group projects. 
• Ability to handle sensitive information with discretion and professionalism.
• Excellent interpersonal, verbal, and written communication skills. 
• Proficiency in Microsoft Office, Google Workspace and utilizing credentialing software and database systems. 

Here’s what we’d like to offer you:

• Equal investment and support for our people and patients.
• A fun and ambitious growing environment with a culture that takes on big things, takes risks, and learns quickly.
• The ability to demonstrate creativity, innovation, and conscientiousness, and find joy in working together.
• A team of highly skilled, incredibly kind, and welcoming employees, every one of whom has something unique to offer.
• We know that the overall success of our business is a collaborative effort, and we strive to provide ongoing opportunities for our employees to learn and grow, both personally and professionally.
• Full-time employees are eligible to participate in our benefits package which includes Medical, Dental, Vision Insurance, Company, and Paid time off, Short- and Long-Term Disability, and more.

Work Environment:
The work environment characteristics described here are representative of those encountered while performing the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually quiet.

Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to person the essential functions.

• While performing the duties of this job, the employee is regularly required to sit, stand, talk, visualize, or hear.

We are an equal opportunity and affirmative action employer. We embrace diversity and are committed to creating an inclusive environment for all employees. Applicants will be considered for employment without regard to race, religion, gender, gender identity, sexual orientation, national origin, age, disability, or veteran status.

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