Credentialing Specialist

 Soleo Health is seeking a Credentialing Specialist to drive the end-to-end credentialing process, ensuring timely payor enrollment, includes support for Medicare enrollment and ongoing compliance to support high-quality patient care and organizational growth. Join us in simplifying complex care! 

Soleo Health Perks:

• Competitive Wages  
• 401(k) with a Match 
• Referral Bonus    
• Paid Time Off 
• Great Company Culture  
• No Weekends or Holidays   
• Paid Parental Leave Options 
• Affordable Medical, Dental, & Vision Insurance Plans 
• Company Paid Disability & Basic Life Insurance 
• HSA & FSA (including dependent care) Options 
• Education Assistance Program   

The Position: 

The Credentialing Specialist plays a pivotal role in managing all aspects of Payor Credentialing and Medicare certifications for our organization. This position is crucial in ensuring that our services comply with the stringent standards set by CMS (Centers for Medicare Services) and Payor credentialing programs. As a central figure in the Credentialing team, the specialist not only leads the strategic planning and execution of certification applications and revalidations but also ensures continuous compliance and operational excellence within the department. Responsibilities include:

• Spearhead the planning and execution of new Payor credentialing applications, managing timelines, resources, and documentation requirements efficiently to meet stringent deadlines.
• Direct the entire lifecycle of Medicare certifications and revalidations. Ensure that all certifications are up-to-date and in alignment with federal regulations.
• Continuously monitor changes in CMS PECOS and Payor credentialing requirements. Proactively communicate updates to relevant stakeholders and adjust processes accordingly to maintain compliance.
• Maintain master payor lists, shared documentation folders and other pertinent tracking tools.
• Oversee the administration of portal access for new users. 
• Lead and delegate the completion of payor applications, re-credentialing applications, adding new branches to existing agreements, and addendums, annual FWA training attestations, etc. including but not limited to private payors, preferred provider organizations, third–party administrators, pharmacy benefit managers, etc.
• Work with Directors Payor Relations and others as applicable to follow up on outstanding credentialing applications and proposals. Provide expert advice and support for departmental and organizational projects that require credentialing insight.
• Collaborate with the Credentialing team to set quality standards for services and products. Ensure that all credentialing activities contribute to the overarching goal of high-quality service delivery.
• Contribute expertise to larger, cross-functional projects, offering support and guidance on issues related to credentialing. Participate in strategic meetings to represent the credentialing perspective and ensure alignment with organizational objectives.

Schedule: 

Monday-Friday 8:30am-5:00pm

• High School Diploma or equivalent required.
• Prior Credentialing experience preferred.
• Experience establishing and maintaining relationships with individuals at various levels of the organization, such as peers, internal/external stakeholders, business partners, senior level managers.
• Demonstrated competencies in the use of information support systems (e.g. PECOS, Smartsheet, Microsoft Word, Excel, PowerPoint, and Outlook.
• Experience applying and maintaining pharmacy or other Licenses.

About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference! 

Soleo’s Core Values:

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.  

Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

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