Credentialing Specialist
Marathon Health is a leading advanced primary care provider, partnering with employer and union plan sponsors to improve health for millions of Americans. With nationwide onsite, nearsite, and network health centers, and virtual primary care, Marathon delivers a value-based model that enhances the healthcare experience for members and providers, while driving meaningful cost savings for plan sponsors. Marathon is proud to be certified as a Great Place to Work®, reflecting the company's commitment to building an inclusive, high-trust culture where all employees can thrive. Learn more at marathon.health
ABOUT THE JOB
The Credentialing Specialist is responsible for coordinating all aspects of the credentialing functions for Marathon Health including ensuring the timely and appropriate coordination, monitoring, and completion of the initial credentialing and re-credentialing verification processes for all contracted practitioners.
ESSENTIAL DUTIES
Coordinate the initial credentialing and recredentialing processes for all healthcare providers.
Collect, review, and verify provider credentials, including education, training, licensure, certifications, and work history.
Ensure timely and accurate submission of credentialing documentation within the credentialing software.
Efficiently use the organization’s credentialing software to track and manage credentialing activities.
Maintain accurate and up-to-date provider records within the credentialing system.
Verify provider credentials through primary source verification (PSV) in accordance with organizational policies and regulatory requirements.
Ensure all provider credentials are current and compliant with state, federal, and organizational standards.
Collaborate with internal departments, such as Talent Acquisition and Operations, to ensure seamless onboarding and credentialing of providers.
Serve as a point of contact for providers regarding credentialing status and requirements.
Assist in preparing credentialing files for review by the credentialing committee.
Participate in quality assurance activities related to the credentialing process to ensure continuous compliance and efficiency.
Identify opportunities for process improvement within the credentialing function and suggest enhancements to the credentialing software or workflows.
Stay informed about changes in credentialing regulations and standards, and update processes accordingly.
Maintain complete and accurate records of all credentialing activities and documentation.
Ensure that all documentation is stored securely and in compliance with organizational policies and regulations.
Other projects, as assigned.
QUALIFICATIONS
Bachelor’s degree in business administration or a health care-related discipline and minimum of 3+ years’ healthcare credentialing experience or equivalent combination of education and experience. CPCS or CPMSM certification preferred.
Knowledge of or familiarity with NCQA and AAAHC credentialing standards; Knowledge of or familiarity with laws and regulations affecting credentialing.
DESIRED ATTRIBUTES
Ability to effectively prioritize and execute tasks on time in a fast-changing environment, comfort with, and prior exposure to, ambiguity in a business environment.
Solid interpersonal, collaborative, and relationship-building skills; ability to interact positively with teammates at various levels across the company and to foster a positive work environment.
Demonstrated time management skills and ability to handle multiple priorities and meet deadlines.
Solid problem-solving skills with the ability to work and think outside the box.
Demonstrated proactive behavior and a "can do" attitude; highly motivated, goal-oriented self-starter.
Strong communications skills including the ability to listen effectively to customers to gain an understanding of client/patient needs and the ability to communicate information clearly and effectively.
WORKING CONDITIONS AND PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Usual office environment with frequent sitting, walking, and standing. Frequent use of eye, hand, and finger coordination enabling the use of office machinery. Oral and auditory capacity enabling interpersonal communication as well as communication through automated devices such as the telephone.
ADA
Marathon Health provides reasonable accommodations to enable otherwise qualified individuals with disabilities to perform the essential Physical and/or Mental functions of a position.
The above statements are intended to describe the essential function of the job being performed by employees assigned to this classification.
The duties listed are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees so classified. All employees may be required to perform duties outside of their normal responsibilities from time to time, as needed. With the evolution of the Company and this role, the responsibilities of this position may change at any time.