About Us

Upperline Health launched in 2017 and is the nation’s leading comprehensive and coordinated lower extremity healthcare organization. Upperline Health provides the highest quality integrated health services to more patients in need through a skilled and compassionate team. We specialize in targeting patients at risk of developing complications and intervening earlier with an innovative care management approach to prevent more serious consequences. Upperline Health is based out of Nashville, TN and currently has practices in Alabama, California, Florida, Georgia, Indiana, Kentucky, and Tennessee.

Benefits

Comprehensive benefit options include medical, dental and vision, 401K and PTO

About the Credentialing Specialist

Upperline Health is seeking a Credentialing Specialist to support a team of clinicians in delivering complex health services in the clinic setting. The Credentialing Specialist will be responsible for credentialing new and established health care providers, and maintenance of relevant information to include source verification, follow up, data collection and entry, as well as document review. In addition to submitting and managing the credentialing process, the Credentialing Specialist is responsible for all duties related to maintaining payer relationships for the purpose of successful provider credentialing. This position will involve engaging existing relationships with major payers on a regional and/or national level while working in a matrixed manner with members of the Revenue Cycle, Business Development, Operations, Finance, Provider Onboarding, and Value Based Care teams regarding contracting. Ideal candidates will have prior experience credentialing providers, and mid-level providers with various insurance companies including Medicare, Medicaid, and major commercial payers. A working knowledge and experience of and with value-based care reimbursement models and the life cycle of value-based care agreements preferred. The candidate must demonstrate organizational skills, detail orientation, flexibility, and ability to work with minimal supervision. As Upperline expands, the Credentialing Specialist will be able to explore a wide range of career opportunities within the company.

This position will work remote. Nashville preferred.

What You’ll Do

• Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals
• Maintain copies of current state licenses, malpractice coverage and any other required credentialing documents for all assigned providers
• Track license and certification expiration dates for all providers to ensure timely renewals
• Lead the credentialing process by collecting relevant information and completing all applications for payers and hospitals
• Act as the point person for collecting information from both providers and payers and being the liaison between the two
• Process and maintain credentialing and re-credentialing information, including but not limited to the following verifications: National Practitioner Data Bank, DEA Verification Licensure, CAQH, Board Certification Training verified, Residency/ Fellowship
• Project manage the credentialing process using timelines, tasks and owners and follow up to ensure timely completion
• Maintain corporate provider contract files
• Assess and report progress in meeting department objectives
• Perform other duties and works on special projects as requested

Qualifications of the Credentialing Specialist

• Minimum of 3 years’ experience in credentialing providers and mid-level providers (Nurse Practitioners)
• Demonstrated knowledge of managed care, including medical-legal issues and laws, Medicare reimbursement methodologies, fee schedule development, legislative regulations, and other national standards
• Work history including roles that required proactive task management and prioritization of competing tasks
• Creative and persistent problem solver with an ability to present solutions to complex problems
• Attention to details and accuracy with an ability to summarize difficult concepts to all levels of management in short, consumable bites and/or concepts
• Demonstrates proficiency in Microsoft Office (Excel, Word) is required
• Ability to maintain confidentiality of privileged information
• NAMSS certified at CPCS level preferred

Compensation

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience

Job Type: Full Time

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