Credentialing Manager

About Curative

Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at $1.275B Curative is scaling rapidly and investing in AI-powered service deeper member engagement and a smart network designed for todays workforce.

Our north star guides everything we do: healthcare only works when people can actually use it. That belief drives every decision we make: from how we design our plan support our members to how we collaborate as a team.

If you want to do meaningful work with a team that moves fast experiments boldly and cares deeply Curative is the place to do it. Were growing fast and looking for teammates who want to help transform health insurance for the better.

SUMMARY

The Credentialing Manager (CM) oversees the credentialing process and assigned staff to ensure compliance with state regulatory requirements for credentialing and recredentialing of participating providers and delegated credentialing processes and audits in accordance with Curative policies and procedures.

The CM is responsible for the daily operations of Credentialing in the Network Operations Department. The CM facilitates communication with clinics physicians payors medical directors in addition to in-house stakeholders.

The CM will be integral in the evolution of Curatives credentialing processes as we look forward to the creation of our own proprietary credentialing platform. The incumbent will be working with Curatives tech team to develop and implement an intuitive and scalable platform to shorten credentialing cycle times by integrating AI into the collection and organization of provider documentation with the goal of reducing and ultimately eliminating the manual processes currently in use.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Manage a small credentialing staff responsible for direct credentialing both physician and facility and overseeing delegated credentialing entities.

• Work with current credentialing vendor on issues related to their software and assist in the development and transition to our new proprietary platform.

• Work with our Operations and Technology teams to assure that provider data is accurately transmitted into the directory and claim system. Some experience with provider data maintenance is preferred.

• Maintaining Tracking and Managing rosters for accuracy and completeness for final reporting that is needed for timely setup for claims payment member assignment and directory display.

• Conduct audits to reduce errors and improve processes and performance maintaining current provider data to ensure the quality of the network

• Coordinate delegation audits to ensure compliance with state federal and NCQA standards including scheduling audits accurately completing delegation audit tools and reporting outcomes to management.

• Participate in team meetings alongside other team members to discuss credentialing issues provide feedback to support with suggestions for the development and improvement of workflow and discuss process improvement change

• Perform medical credentialing file/element investigation and primary source verification of provider and facility initial and re-credentialing applications utilizing established standards state regulatory and NCQA requirements.

• Ensure timely compilation of applicant and verification elements to prevent any adverse outcomes or delays in processing applications/files.

• As needed prepares agendas and related material for all Credentialing Committee meetings including transcribing and maintaining minutes for such meetings along with ensuring expeditious follow- through on action items and policy changes.

• Analyzing credentialing standards and developing criteria to ensure compliance; revising general aspects of the credentialing and privileging process as necessary; making recommendations for revisions in development current operating environment standards and enhancements as appropriate to the current policies and procedures.

• Ongoing monthly monitoring to ensure the quality and safety of care to members. Also monitors for sanctions and tracks complaints adverse events and quality issues against practitioners through monthly queries and reports.

• Work adhering to US regulatory and Quality System requirements (21 CFR 820 etc).

• This position assumes and performs other duties as assigned.

QUALIFICATIONS (REQUIRED)

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• 5 years of provider credentialing experience 1-year supervisory experience to include managing offshore resources.

• High degree of knowledge in NCQA and/or JCO credentialing standards.

• Proficient computer experience i.e. Google Suite and Microsoft Suite of applications.

• Significant experience with credentialing software (Medallion CAQH CredSimple).

• Experience with Process Improvement.

• Excellent written verbal presentation and leadership skills. Self-starter who can work independently with minimal supervision.

QUALIFICATIONS (PREFERRED)

• Certifications - CPCS CPMSM College Degree
• Managed Care/Hospital Credentialing
• Experience with Texas Dept of Insurance (TDI) practices and standards
• Proficient in Google Suite of applications Microsoft Word/Excel Adobe TrueForm Access and/or credentialing software programs

EDUCATION and/or EXPERIENCE

• Bachelors Degree (BA) from four year college or university or one to two years of related experience and/or training or equivalent work experience with focus in credentialing.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations 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 sit; use hands to operate a computer; talk; and hear.

For this position the percentage of expected Travel is: 5 % of the time

Perks & Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)

  • $0 copays and $0 deductibles (with completion of our Baseline Visit )

  • Preventive and primary care built in

  • Mental health support (Rula Televero Two Chairs Recovery Unplugged)

  • One-on-one care navigation

  • Chronic condition programs (diabetes weight hypertension)

  • Maternity and family planning support

  • 24/7/365 Curative Telehealth

  • Pharmacy benefits

• Comprehensive dental and vision coverage

• Employer-provided life and disability coverage with additional supplemental options

• Flexible spending accounts

• Flexible work options: remote and in-person opportunities

• Generous PTO policy plus 11 paid annual company holidays

• 401K for full-time employees

• Generous Up to 812 weeks paid parental leave based on role eligibility.