Credentialing Specialist

Soleo Health Inc•Frisco, TX

About The Position

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! 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.

Requirements

High School Diploma or equivalent required.
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.

Nice To Haves

Prior Credentialing experience preferred.

Responsibilities

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.