Credentialing Representative

Join us in transforming healthcare.

About Longevity

At Longevity, we're dedicated to advancing healthcare through innovation, compassion, and excellence. We're looking for passionate individuals to join our team and help us make a difference. The individual holding this position is required to support and demonstrate their commitment to Longevity Health's purpose: To optimize the quality of life of people in long-term care by focusing on their individualized health needs.

About the Role

The Credentialing Representative is responsible for supporting the credentialing and re-credentialing process for healthcare providers participating in the health plan's network. This role ensures the accuracy, integrity, and timeliness of all credentialing documentation and maintains compliance with regulatory standards, accreditation requirements, and organizational policies. The Credentialing Representative is also responsible for managing delegated credentialing reviews, ensuring delegated entities meet all standards and requirements.

Key Tasks and Responsibilities:

• Coordinate and facilitate the initial credentialing and re-credentialing process for physicians, allied health professionals, and facilities.
• Lead and oversee delegated credentialing reviews, including evaluation of delegated entities and verification of compliance with regulatory, accreditation, and organizational standards.
• Review and verify provider applications, licensure, certifications, education, work history, and other credentials through primary source verification.
• Maintain and update provider information in the credentialing database and ensure records are accurate and complete.
• Communicate with providers, office staff, and internal departments to obtain required documentation and resolve discrepancies or missing information.
• Monitor credentialing timelines and follow up to ensure timely completion of all credentialing and re-credentialing activities.
• Prepare files and documentation for Credentialing Committee review and participate in committee meetings as needed.
• Ensure compliance with federal, state, and accreditation standards (e.g., NCQA, CMS, URAC) and assist with audits and surveys.
• Generate reports on credentialing status and maintain confidentiality of sensitive provider information.

Supervisory Responsibilities:

• There are no supervisory responsibilities for this position.

Credentials & Coverage:

• There are no licensure requirements for this position.
• Auto insurance coverage as required by your state of residence. New employees will be responsible for providing proof of coverage prior to hiring and on an ongoing basis.

Education and Training:

• High school diploma or equivalent required.
• Bachelor's degree in a healthcare related field preferred.

Knowledge and Experience:

• Experience: Minimum of 3 years of experience in provider contracting within a managed care environment.
• Exceptional communication and interpersonal skills.
• Strong problem-solving and conflict resolution abilities.
• Proficiency in data analysis and interpretation.
• Ability to work independently and collaboratively within a team.
• Familiarity with managed care principles and healthcare regulations.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).

Core Competencies:

Decision Making

• Uses sound judgment to make good decisions based on information gathered and analyzed.
• Consider all pertinent facts and alternatives before deciding on the most appropriate action.

Teamwork

• Interacts with people effectively.
• Able and willing to share and receive information.
• Cooperates within the group and across groups.

Work Standards

• Sets and maintains high performance standards.
• Pay close attention to detail, accuracy, and completeness.
• Shows concern for all aspects of the job and follows up on work output.

Motivation

• Displays energy and enthusiasm in approaching the job.
• Maintains high level of productivity and self-direction.

Reliability

• Takes personal responsibility for job performance.
• Completes work in a timely and consistent manner.
• Sticks to commitments.

Problem Solving

• Analyses problems by gathering and organizing all relevant information.
• Identifies cause and effect relationships.
• Comes up with appropriate solutions.

Adaptability

• Adapts to changing work environments, work priorities, and organizational needs.
• Able to effectively deal with change and diverse people.

Planning and Organizing

• Plans and organizes tasks and work responsibilities to achieve objectives.
• Schedules activities.
• Allocates and uses resources properly.

Communication

• Expresses ideas effectively.
• Organizes and delivers information appropriately.
• Listen actively.
• Shares complete and accurate information.

Integrity

• Maintains confidentiality.
• Meets own commitments.
• Adheres to organizational policies and procedures.

Initiative

• Takes action to influence events.
• Generates ideas for improvement.
• Takes advantage of opportunities.

Stress Tolerance

• Displays emotional resilience.
• Ability to withstand pressure on an on-going basis.
• Deals with difficult situations while maintaining performance.
• Seeks support from others when necessary.

Working Conditions:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

The noise level in the work environment is usually moderate (i.e., office setting with office equipment operating).

Physical Requirements:
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 Under the Americans with Disabilities Act (ADA) may be made to enable individuals with disabilities to perform the essential functions.

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

Company Overview

Longevity Health is a national provider of Institutional Special Needs Plans (I-SNP), created to meet the complex healthcare needs of nursing home residents. Since our founding in 2018, we've expanded our services across several states and formed strategic partnerships to deliver high-quality, patient-centered care. We are actively growing, with plans to continue expanding our services across the nation.

Longevity Health is an Equal Opportunity Employer. We value diversity and encourage applicants of all backgrounds to apply.

COVID-19 Vaccination Policy

Longevity Health follows federal and state regulations regarding COVID-19 vaccinations. Some facilities may still require staff vaccinations to protect the health of residents. Applicants will be required to provide proof of vaccination, or an approved exemption, where applicable.

If you are passionate about healthcare and ready to help us drive change in long-term care, apply now to join the Longevity Health team

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