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Credentialing Specialist - Payor Partnerships

Company: FOLX Health
Location: Boston
Posted on: January 27, 2023

Job Description:


The Credentialing Specialist will serve as a vital member of the Licensing and Credentialing Team at FOLX Health, responsible for driving health plan credentialing across both national and regional payor accounts. They will also provide day to day support in broader licensing and credentialing efforts.
Our Company:FOLX Health exists to be the leading health and wellness platform for LGBTQIA care, providing end to end services, both virtually and in person, across the spectrum of community needs. We are the north star for innovation in the broader ecosystem by creating joyful, affirming healthcare on one's own terms and building community and access around those needs.
Our Culture:Reliability: We show up for our members and each other in service of our mission.Transparency: We build trust by openly sharing our goals and progress.Access: We invest in our team by providing the tools and training needed to achieve individual goals.Agency: We trust our team to get their jobs done.
What You'll Do:

  • Completes and processes payor enrollment applications for FOLX and FOLX providers for identified plans; completes timely follow up on all payor enrollment applications
  • Builds and maintains strong partnerships with payors
  • Completes credentialing applications and assembles documentation as required by payors
  • Ensures that re-credentialing is completed in a timely manner to prevent any lapse in enrollment
  • Documents workflow actions in appropriate systems and databases
  • Troubleshoots when issues arise with external credentialing boards, systems, etc.
  • Maintains accurate provider profiles on CAQH and in any applicable credentialing software
  • Assists with monitoring and maintaining current documents (License, DEA, CDS, Exclusions, Board Certifications)
  • Terminates enrollment with payors upon resignation or termination of providers
  • Other tasks as assigned
    What You'll Bring:
    • A passion for serving the LGBTQ+ Community
    • 4+ years experience in payor credentialing, health plan operations or similar roles
    • Knowledge of the healthcare industry with particular emphasis on health plans and credentialing
    • Knowledge of credentialing systems and databases like CAQH
    • Ability to quickly and effectively build strong professional relationships with internal teams and external payor partners
    • Creative and flexible thinking skills with strong organizational skills and the ability to prioritize and coordinate multiple projects
    • Strong attention to detail with the ability to complete a high volume of tasks accurately, within set SLA timelines and with minimal supervision
    • Ability to think critically, analyze and solve problems
    • Readiness and willingness to learn new skills and adapt to changes quickly
    • Calm and effective functioning in high pressure and urgent situations
    • Understanding of HIPAA and how to manage confidential information and/or issues using discretion and judgment
      Salary range: $75,000 - $95,000
      We are proud to be an equal opportunity employer, and do not discriminate on the basis of race, color, ethnicity, national origin, religious affiliation, sex, gender identity, sexual orientation, disability, or any other legally protected status. Here, diversity and inclusion means accepting that everyone's perspective can teach you something. We're eager to learn.

Keywords: FOLX Health, Boston , Credentialing Specialist - Payor Partnerships, Other , Boston, Massachusetts

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