Senior Credentialing Specialist (Remote)

| Columbus, OH +80 more | Remote
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Company

At Circulo, we believe that everybody, no matter who they are, deserves personalized and proactive health care. With services guided by empathy, innovation and cutting-edge technology, we’re building the future of care focused on better health for the people we serve. Circulo Health is putting humanity back in health. We’ve built a team of talented, enthusiastic professionals. Join us today.


The Role


The Senior Credentialing Specialist will be a team player with an aptness for organization. The Credentialing Specialist is responsible for updating physician and mid-level providers with contracted insurance carriers. This individual will also assist in maintaining physician privileges at area hospitals, skilled nursing facilities and ambulatory surgery centers. The Senior Credentialing Specialist maintains current accurate information for the physicians and mid-level providers in Circulo’s database, with insurance carriers, and facilities. This position will report directly to the Director, Network Contracting.

Who we are looking for

  • 5+ years of experience in a provider credentialing role in a health plan and/or physician practice. 
  • Ambitious self-starter with excellent time management and communication skills (written and verbal).
  • This individual must measure, adapt and have the ability to execute deliverables within time sensitive deadlines. 
  • Detailed-oriented individual with exceptional organizational skills.
  • Ability to assess departmental needs and build strategies for scalable resolution.

What you will do

  • Collect, verify and submit CAQH profile data with supporting documents and ensure contracted payers receive updated information; facilitates provider re-attestations of CAQH data as required by CAQH and payers.
  • Support medical professionals, as it relates to collecting, uploading and auditing personal documentation including resume, insurance/liability policies, licenses and diplomas and certifications.
  • Apply general guidelines in determining whether a provider meets criteria and documents deficiencies.
  • Follow legal, State and Federal Agencies, State Licensing Board regulations and payer guidelines.
  • Process re-credentialing applications.
  • Develop and maintain policies & procedures for each facility/practice per state. 
  • Assist in researching pended applications and resolving discrepancies.
  • Build file documentation and prepare file for credentialing committee review.
  • Prepare status reports on activities, specifically to report on the number of professionals in the pipeline for each payer.

Our Perks... Here are some highlights:

  • Medical, Dental, and Vision: 100% of premiums are covered by Circulo for quality care for all team members and their dependents
  • Stock Options: all team members receive stock options
  • 401(k) program: all team members have access to our 401(k) savings program and all administration costs are covered by Circulo along with providing a 3% match
  • Vacation: time off is not just unlimited, it’s required (minimum of 3 days a quarter)
  • Parental Leave: 10 weeks fully paid time off for all new parents with flexible scheduling and additional unpaid leave available

#BI-Remote

#LI-Remote

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