Credentialing and Licensure Specialist

Skills Required

• Proven background in credentialing, with experience handling both individual and group credentialing applications.
• Ability to create and maintain databases for credentialing approvals and processes with reporting across multiple internal teams.
• Understanding of medical record reviews and chart audits, and an ability to navigate EHRs.
• Understanding of the healthcare industry, particularly in working with health insurance companies, healthcare provider organizations, or other healthcare services companies.
• Ability to manage complex processes and maintain accuracy across multiple provider records.
• Strong verbal and written communication skills to collaborate effectively with internal teams and external stakeholders.
• Ability to prioritize tasks and manage competing deadlines in a fast-paced, goal-oriented environment.
• Comfort with using various software programs, including Microsoft Office, Jira, and clinical applications (EHR, care management systems).
• Demonstrated ability to adjust to evolving priorities and workload demands in a virtual, dynamic environment.

Key Behaviors

• Accountability: Takes ownership of the credentialing process, ensuring all tasks are completed in a timely and efficient manner.
• Collaboration: Works well with cross-functional teams, maintaining open communication and contributing to a positive, supportive work environment.
• Attention to Detail: Demonstrates exceptional focus on detail, ensuring that all submissions and approvals are accurate and tracked.
• Flexibility: Adapts quickly to changing processes, priorities, and workload, managing multiple responsibilities without compromising quality.
• Professionalism: Maintains a professional approach with both internal and external stakeholders, exemplifying Upward Health’s values at all times.

Competencies

• Problem-Solving: Capable of identifying issues and developing solutions independently while managing the complexities of the credentialing process.
• Organization: Effectively manages multiple tasks, timelines, and deadlines while keeping records organized and up-to-date.
• Communication: Clearly communicates processes, updates, and issues with both team members and external parties.
• Customer Focus: Demonstrates a strong commitment to understanding and meeting the needs of both internal teams and external health plan representatives.
• Leadership: Though not a supervisory position, exhibits leadership qualities by driving efficiency, offering guidance, and ensuring team alignment on goals.

Upward Health Core Values

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Upward Health Benefits

Upward Health is dedicated to providing competitive benefits to its employees, including health insurance, retirement plans, paid time off, and more. Details on specific benefits can be found in the employee handbook.

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