Credentialing Specialist

4 weeks ago

Buffalo, United States CINQCARE Full time
Job DescriptionJob 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 Black and Brown 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 Family Members’ race, culture, and environment is critical to delivering improved health outcomes. By empowering Family Members, 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.

About You

The Credentialing Specialist reports to the Director of Practice Implementations, with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE’s requirements. They should embody CINQCARE’s core values, including, Trusted, Empathetic, Committed, Humble, Creative and Community-Minded. At CINQCARE, we don’t have patients or customers – we have Family Members.

  • Education. High school diploma or GED; at least three (3) years of experience directly related to the duties and responsibilities specified.
  • Experience.
    • Excellent time management
    • Ability to communicate effectively both orally and in writing.
    • Information research skills.
    • Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
    • Working knowledge of clinical and/or hospital operations and procedures.
    • Ability to use independent judgment and to manage and impart confidential information.
    • Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
    • Ability to make administrative/procedural decisions and judgments.
    • Demonstrated advanced working knowledge of Microsoft Word and Excel.
    • Ability to learn new applications to function effectively in a remote work environment.
    • Skill in establishing priorities with independent coordination of day-to-day aspects.
    • Advanced skills in computerized spreadsheeting and database management

About the Job

The Credentialing Specialist will have the following responsibilities:

  • Process health plan applications via electronic portals, i.e. – PECOS, Availity, NaviNet, and health plan websites, as well as paper enrollments.
  • CAQH profile creation (when necessary), updating of profiles and ongoing maintenance.
  • Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, and local regulations, guidelines, policies, and standards.
  • Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and Care Medical Practice / Care at Home criteria.
  • Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  • Enters, updates and maintains data from provider applications into credentialing database and EMR, in accordance with internal policies and procedures.
  • Participates in the development and implementation of process improvements for the system-wide credentialing process.
  • Performs miscellaneous job-related duties as assigned.


CINQCARE provides all employees working an average of 30+ hours/week with the option to enroll in healthcare benefits. The cost of healthcare is shared between the company and the employee.

The working environment and physical requirements of the job include:

This position requires both in-home and office-based work. In-office work is performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace.

In this position you will need an ability to 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. 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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