Credentialing Specialist

Credentialing Specialist

Full Time - Exempt

Columbus, OH

And Health is a healthcare technology company created to radically improve access and outcomes to specialty care. We are driven by the goal of making world-class specialty care accessible and affordable to all. We partner with health systems, community health centers, plans, and employers to remove barriers to care to ensure all people have access to the care they deserve.

We are seeking a dedicated Credentialing Specialist who can play a key role in the payer enrollment and credentialing processes for all And Health licensed and certified healthcare professionals. This role will collaborate with internal teams and external partners to ensure compliance and uphold the highest standards of quality and patient safety.

• Ensure timely and accurate submission of payer enrollment and credentialing applications and packets.
• Provide comprehensive support for credentialing activities, including tracking and reporting.
• Maintain strong communication with payers and partners to facilitate enrollment and compliance.

• Lead payer enrollment activities for And Health’s partners, ensuring timely and accurate submission of all payer enrollment documents to partners.
• Accurately input and track payer enrollment statues for all partners, maintaining comprehensive records for all activities.
• Prepare and distribute reports on enrollment status and credentialing activities for internal use and external audits.
• Establish and maintain effective communication with payer representatives and And Health’s partners to resolve any issues related to enrollment and credentialing.
• Create and maintain internal guides outlining payer enrollment processes and best practices.
• Gain an in-depth understanding of the payer landscape in states where we are doing business, with an emphasis on Medicaid and the broader payer mix.
• Support ongoing education and training of And Health staff regarding payer enrollment requirements, processes, and landscapes in states where we are doing business.
• Maintain a highly organized system, inclusive of tracking mechanisms, for credentialing schedules, files, and documentation.
• Provide periodic updates to Credentialing Lead and respective And Health teams on credentialing and payer enrollment statuses.
• Assist the Credentialing Lead in all credentialing-related activities for partners, including primary source verifications, license renewals, CAQH profile updates, and preparation of credentialing and re-credentialing applications for And Health providers, clinical pharmacists, pharmacy team members and other non-clinical staff.
• Maintain knowledge of current partners, government agencies, and general requirements for credentialing And Health professionals.
• Collaborate with legal and compliance to ensure adherence to relevant laws, regulations, and contractual obligations related to credentialing, licensure and payer enrollment.
• Participate in internal partner related meetings and discussions, providing appropriate and timely responses to payer enrollment processes and timelines.
• Participate in external partner meetings to obtain updates on payer enrollment related activities.
• Assist with special projects as needed.

• Bachelor’s degree is preferred.

• 2+ years of experience credentialing in healthcare credentialing, payer enrollment or experience working in a healthcare-related role.
• Experience with credentialing under FQHC and HRSA standards is a plus.
• You subscribe to and are willing to live our culture creator values.
• Impeccable attention to detail and are attentive and present in your work.
• Ability to thrive on change and can quickly adapt to evolving…