Sr. Specialist, Credentialing

About the Role

Day-to-day, this involves managing and escalating complex credentialing issues, collaborating with cross-functional teams, and analyzing trends in provider and facility credentialing. The role requires a strong quantitative and analytical mindset, with the ability to identify problems proactively and develop effective solutions. The incumbent will report to the Manager, Provider Credentialing, and will be integral in supporting process improvement initiatives for the credentialing team.

Oscar Health's commitment to leveraging technology to enhance the healthcare experience makes this role particularly exciting for those interested in the intersection of health insurance, technology, and operations. With a focus on serving members and a relentless pursuit of innovation, the company offers a dynamic environment for professional growth and development.

What You Will Do

• Manage and resolve complex credentialing issues that require in-depth analysis and creative problem-solving.
• Act as a subject matter expert for credentialing, providing guidance and support to internal stakeholders.
• Collaborate with cross-functional teams to identify and resolve systemic issues impacting credentialing.
• Analyze and trend provider and facility credentialing issues to inform process improvements.
• Develop and maintain relationships with stakeholders to ensure effective communication and resolution of escalated issues.
• Support the development and implementation of credentialing process improvements.
• Ensure compliance with all applicable laws and regulations related to credentialing.
• Manage queue work and assigned caseload efficiently, utilizing dashboard management tools.
• Communicate effectively with internal teams and external partners to resolve issues and improve processes.
• Participate in team meetings and company events as required, which may involve occasional travel.

What We Are Looking For

• 1+ years of experience in credentialing for facilities, adhering to NCQA standards.
• 2+ years of previous work experience in a fast-paced, volume-based environment.
• 2+ years of strong quantitative or analytical skills, with a focus on problem-solving.
• Experience working in health insurance, preferably with a background in credentialing.
• Strong verbal and written communication skills, with excellent interpersonal interactions.
• Ability to work remotely with minimal supervision, while maintaining productivity and meeting deadlines.
• Proficiency in using credentialing or provider data repositories.
• Experience with healthcare data, such as provider data, and primary source verification.
• High school diploma or GED required; Bachelor's Degree preferred.

Nice to Have

• 1+ years of credentialing experience for practitioners, adhering to NCQA standards.
• Proficiency with non-Microsoft business platforms.
• Background in health insurance, with a deep understanding of regulatory requirements.
• Experience with process improvement methodologies.
• Certification in credentialing or a related field.

Benefits and Perks

• Competitive salary.
• Comprehensive benefits package, including medical, dental, and vision benefits.
• 11 paid holidays, paid sick time, and paid parental leave.
• 401(k) plan participation and life and disability insurance.
• Paid wellness time and reimbursements for health and wellness activities.
• Opportunity to work with a pioneering health insurance company that leverages technology for innovation.
• Flexible, remote work environment with occasional travel for team meetings and company events.
• Professional development opportunities in a rapidly growing company.
• Access to cutting-edge technology and tools to support your work.

• Ensure you have a strong understanding of NCQA standards and credentialing processes for both facilities and practitioners.
• Highlight your analytical and problem-solving skills, as these are crucial for managing complex credentialing issues.
• Showcase your experience with credentialing or provider data repositories and any proficiency with non-Microsoft business platforms.
• Prepare to discuss your approach to process improvement and how you've applied it in previous roles.
• When negotiating salary, consider factors such as your experience, the cost of living in your area, and the company's overall compensation package.
• Be prepared to ask questions about the company culture, team dynamics, and opportunities for professional growth during the interview.
• Pay attention to the company's commitment to diversity, equity, and inclusion, and be ready to discuss how your skills and experience align with these values.