Credentialing Specialist

OpenLoop is looking for a Credentialing Specialist to join our team remotely. This role will be a member of the Credentialing & Licensing Team, collaborating closely with the Credentialing & Licensing Manager. 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 that all providers meet the necessary qualifications and maintain compliance with industry standards. You will collaborate closely with clinicians, compliance teams, and regulatory bodies to facilitate timely and accurate credentialing submissions and renewals, thereby supporting the delivery of high-quality patient care.   What You'll Do:

• Credentialing Management:
  • 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.
• Documentation and Database Maintenance:
  • Maintain and update credentialing documentation in the company’s credentialing database.
  • Ensure all credentialing records are accurate, complete, and up-to-date.
• Tracking and Monitoring:
  • 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.
• Communication and Coordination:
  • Serve as a point of contact for providers regarding credentialing inquiries and status updates.
  • Communicate effectively with regulatory agencies, insurance companies, and internal stakeholders as necessary.
• Compliance and Quality Assurance:
  • 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 credentialing requirements and implement necessary adjustments.
• Problem Resolution:
  • Identify and resolve any issues or discrepancies in credentialing documents and processes.
  • Manage communications with accrediting bodies to address and resolve escalated credentialing issues.
• Process Improvement:
  • Proactively identify opportunities to enhance the credentialing process and implement best practices.
  • Stay updated on industry trends and advancements in credentialing to continuously improve processes.
• Administrative Support:
  • Assist with preparing reports and presentations related to credentialing activities.
  • Perform other administrative tasks as required by the credentialing team.

Who You Are:

• • 1-2 years of experience in healthcare credentialing, regulatory compliance, or a related field.
  • Familiarity with NCQA CVO guidelines and multi-state credentialing processes is highly desirable.
  • Detail-oriented with strong organizational and time-management skills.
  • Excellent communication skills, both written and verbal, for effective interaction with providers and regulatory bodies
  • Experience with provider data management systems such as MDStaff.
  • Proficiency in using credentialing software and E-Ticketing systems (e.g., Jira, Zoho Desk) is a plus.
  • 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.
  • Certification in Credentialing (e.g., Certified Provider Credentialing Specialist) is advantageous.
  • Experience working within an NCQA-accredited CVO or similar credentialing organization.

 

Remote Salary Range$50,000—$55,000 USD

 

About OpenLoop

OpenLoop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring healing anywhere. Our tele-health 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.

Our Company Culture

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.

Our Benefits

In addition to the salary for this role, you would also be eligible for:

• Medical, Dental, and Vision plans

• Flexible Spending/Health Savings Accounts

• Unlimited PTO

• 401(k) + Company Match

• Life Insurance, Pet insurance, and more

 

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

 

 

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