Credentialing Specialist

Credentialing Specialist

Upperline Health is the nation's largest provider group dedicated to lower extremity, wound and vascular care. Founded in 2017 with the ambitious goal of transforming specialty care, Upperline Health is a pioneer in bringing value-based care models into specialty care. Upperline delivers a more efficient path for patients to receive consistent and effective treatment for chronic illnesses.

Triage is temporary. Treatment is transformative. Upperline Health providers coordinate patients' care among a team of specialists – physicians, advanced practice providers, care navigators, pharmacists, dieticians, and social workers for integrated treatment that addresses patients' immediate and long-term health needs.

We put patients at the center of value-based care.

This position is open to remote candidates who actively reside in the following states: AL, AZ, FL, GA, IN, IL, KY, MI, NC, NV, OH, PA, SC, TN, and TX.

About the Credentialing Specialist Position Upperline Health is seeking a Credentialing Specialist to support a team of clinicians in delivering complex health services in the clinic setting. The Credentialing Specialist will be responsible for credentialing new and established healthcare providers, and maintenance of relevant information to include source verification, follow up, data collection and entry, as well as document review. In addition to submitting and managing the credentialing process, the Credentialing Specialist is responsible for all duties related to maintaining payer relationships for the purpose of successful provider credentialing.

This position will involve engaging existing relationships with major payers on a regional and/or national level while working in a matrixed manner with members of the Revenue Cycle, Business Development, Operations, Finance, Provider Onboarding, and Value Based Care teams regarding contracting. Ideal candidates will have prior experience credentialing providers, and mid-level providers with various insurance companies including Medicare, Medicaid, and major commercial payers. A working knowledge and experience of and with value-based care reimbursement models and the life cycle of value-based care agreements preferred. The candidate must demonstrate organizational skills, detail orientation, flexibility, and ability to work with minimal supervision. As Upperline expands, the Credentialing Specialist will be able to explore a wide range of career opportunities within the company.

What You'll Do:

• Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals.
• Lead the credentialing process by collecting relevant information and completing all applications for payers and hospitals.
• Act as the point person for collecting information from both providers and payers and being the liaison between the two.
• Process and maintain credentialing and re-credentialing information, including but not limited to the following verifications: National Practitioner Data Bank, DEA Verification Licensure, CAQH, Board Certification Training verified, Residency/ Fellowship.
• Project manage the credentialing process using timelines, tasks and owners and follow up to ensure timely completion.
• Assess and report progress in meeting department objectives.
• Perform other duties and works on special projects as requested

Required Skills & Competencies:

• 5-7+ years of direct healthcare credentialing / privileging on a multi-state, multi-entity scale
• 2+ years of direct implementation and utilization of credentialing software
• Knowledge of practice consolidation via mergers & acquisitions
• Experience with delegated credentialing preferred
• Demonstrated knowledge of managed care, including medical-legal issues and laws, Medicare reimbursement methodologies, fee schedule development, legislative regulations, and other national standards
• Expertise in creating & maintaining PECOS profiles and enrollments
• Knowledge of revenue cycle and direct impacts from provider credentialing
• Proficiency in Microsoft Office (Excel, Word, Outlook) is required
• Ability to plan, organize and prioritize work independently and meet deadlines
• Excellent attention to detail and accuracy
• Ability to communicate clearly and concisely summarize difficult concepts to all levels of
• Strong understanding and compliance with HIPAA privacy requirements

Benefits Comprehensive benefit options include medical, dental and vision, 401K (matching), PTO and parental leave.

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience.

Job Type: Full-time

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.