Credentialing Specialist

Who We Are TwelveStone Health Partners is focused on the medication needs of patients with chronic, complex and rare conditions. For more than 35 years, TwelveStone Health has been dedicated to finding new ways to deliver care designed around the patient. Chronic conditions include Multiple Sclerosis, NMOSD, Myasthenia Gravis, CIDP, ITP, Migraine Prevention, Crohn’s Disease, Ulcerative Colitis, Plaque Psoriasis, Alpha 1 Antitrypsin Deficiency, Primary Immunodeficiency, hATTR Amyloidosis, Thyroid Eye Disease, and many others. Description For patients, we provide access to the most advanced medications, along with personal and financial support needed to live with chronic conditions. For providers, we simplify treatment for complex conditions by eliminating the administrative and clinical burdens placed on practices when patients need innovative specialty medications. TwelveStone Health Partners supports the transition from acute to post‑acute care environments and the journey from sickness to health. We are licensed in 50 states. Summary We are hiring for the position of Credentialing Specialist. The Credentialing Specialist is responsible for all administrative aspects of credentialing services and verifying submitted credentialing documentation for individual practitioners, infusion centers, and home infusion therapy contracts. The specialist will meet all credentialing turnaround time requirements by submitting accurate and complete applications, comply with all policies and processes to meet state, regulatory, health/safety, and compliance guidelines, and maintain accurate provider information. Essential Duties & Responsibilities Manage completion and submission of individual practitioner, facility and PBM credentialing or re‑credentialing applications, approval, denial, termination letters, and accurately load provider information in the credentialing database (CAQH, Availity, etc.) and maintain provider tracking logs (Excel). Enroll providers, infusion centers and home infusion pharmacies in State Medicare/Medicaid. Coordinate outreach to obtain needed documents and escalates missing items to leadership to avoid credentialing lapses. Follow‑up to ensure credentialing information is accurate, updated and resolved in a timely manner. Communicate with insurance, State Medicare/Medicaid and payors to resolve credentialing issues. Complete yearly revalidations and other requests to ensure accuracy and avoid delays in payment and authorizations. Understand specific application requirements for each payor, including prerequisites, required forms, roster form completion, supporting documentation (DEA, CV, Accreditation, etc.) and regulations. Create and maintain provider files in compliance with organization policies. Prepare documentation and reporting regarding provider enrollments in process. Retain records related to completed payor credentialing applications. Ensure data integrity and confidentiality of credentialing records. Perform quality checks, proactively verify enrollment of all providers and lines of business with payors, CMS and State Medicaid. Establish close working relationships with Compliance, Contracting and Revenue Cycle as well as payor contacts. Abide by all policies, procedures and work instructions for the credentialing function. Coordinate credentialing and re‑credentialing processes, maintain task grids and systems to assure follow‑up and completion. Continuously monitor payor enrollment to ensure accuracy of all provider information. Keep communication with all internal departments. Manage Credentialing email. Assist in goals and performance standards management. Other duties and special projects as assigned. Requirements Education: High School Diploma or GED required; Associate’s Degree a plus. Experience: 2+ years of payor credentialing experience, or 3+ years of healthcare‑related experience preferred. Previous relevant experience may include billing, intake, processing, compliance, contracting, etc. Confidentiality: Maintain strict confidentiality regarding protected health information and adhere to HIPAA Privacy & Security policies and procedures. Protect provider and practice information. Functional Competencies: Attention to detail, critical thinking, prioritization, problem solving, approachable, phone etiquette, dependability, verbal and written communication, teamwork, cooperation, collaboration, judgment. #J-18808-Ljbffr TwelveStone Health Partners