Job Description

About CINQCARE

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

Overview

Credentialing is the process of evaluating the academic qualifications and clinical practice history of a practitioner to ensure an overall safe health care system. Following NCQA’s credentialing standards to sustain a high-quality credentialing process across the delivery system, which includes health plans, physician groups, telehealth, and other entities with a network of practitioners. This position reports to the Senior Director, Credentialing & CPA. The Credentialing Specialist should embody CINQCARE's core values, including Trusted, Empathetic, Committed, Humble, Creative, and Community­ Minded.

Primary Responsibilities

The Credentialing Specialist will have the following responsibilities:

• Responsible for all aspects of the Credentialing & Recredentialing processes of all employed and contracted advanced practitioners ensuring compliance with NCQA Standards, CMS Regulations, State & Federal laws, and delegate requirements.
• Recredential practitioners within 36 months of previous approval
• Provide practitioner support with CAQH, application, and various other customer support functions
• Primary source verifies and analyzes all credentials from education to present day directly from the sources.
• Identifies adverse actions in detail and presents to committee for sound decision making in accordance with the policy and procedures. Documents credentialing committee meeting minutes and outcomes.
• Monitor licenses and all other non-static credentials for expiration dates and advise practitioners to renew required credentials
• Notify practitioner, Provider Enrollment Team, and others of approval, expirations, suspensions, terminations, & various other communications related to credentialing data and determination
• Ongoing continuous monitoring of licensing, certifications, & sanctions for adverse actions
• Maintain numerous practitioner data repositories with medical training, education, experience, and licensure
• Implement various federal rulings and accrediting body standards
• Process Status Changes when adding, removing, or transferring states
• Process terminations with CINQ Connect & delegators
• Endure delegation pre-assessment, semi-annual, quarterly, and annual audits
• Leverage CAQH, MD-Staff, MD-App, NPDB, and other platforms which host credentialing data/verifications
• Responsible for maintaining the data integrity contained within the credentialing database
• Work closely with practitioners and leadership surrounding credentialing specific needs and topics
• Perform termination of credentialing procedures when a practitioner leaves the organization to include dis-enrollment of NPDB and CAQH
• Execute Collaborative Practice Agreement (CPA) contracts
• Apply for malpractice/liability coverage for each employed practitioner
• Providing back-up coverage for colleagues and leadership when necessary

General Duties

The Credentialing Specialist should have the following duties:

• Strategy : The Credentialing Specialist will suggest new programs, procedures and policies to continually improve efficiency and morale and to improve the employee experience.
• Collaboration : The Credentialing Specialist will participate in development of people objectives and systems, including metrics, queries, and standard reports for ongoing company requirements
• Knowledge: The Credentialing Specialist will provide subject matter expertise in the credentialing solutions, including determining and recommended approaches for NCQA Standards, solution deployment and performance evaluation.
• Culture : The Credentialing Specialist is accountable for creating a productive, collaborative, safe and inclusive work environment for the credentialing team and as part of the larger Company.

Qualifications

The Credentialing Specialist should have the following qualifications:

• Education:

o High School Diploma required

o Certification as a Certified Provider Credentialing Specialist (CPCS) and/or Certified Provider Medical Services Management (CPMSM), preferred

• Experience: A minimum of 4 years of experience as a Credentialing Specialist or similar role.
• Communication: Excellent verbal, written communication, and presentation skills; Exceptional interpersonal and communication skills Proficiency in all Microsoft Office applications
• Relationships: Ability to build and effectively manage relationships with business leaders, coworkers, and clients.
• Culture: Good judgment, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding and entrepreneurial company.

Our Benefits

At CINQCARE, we care for our team like we care for our patients—holistically. We offer flexible, comprehensive benefits so you can thrive while delivering top-notch care.

• Medical Plans: Two comprehensive options offered to Team members.
• 401K: 4% employer match for your future.
• Dental & Vision: Flexible plans with in-network savings.
• Paid Time Off: Generous PTO, holidays, and wellness time.
• Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company-provided phones for field staff.

The working environment and physical requirements of the job include:

Work is performed indoors in a setting with conditioned air and artificial light. Travel to and work in offices or other environments is required.

In this position you will need an to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.

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