Job title: Licensing & Credentialing Specialist
Company: Oshi Health
Job description: Are you a healthcare enthusiast seeking the opportunity to revolutionize digestive health care and build a national-scale, telehealth-based provider group?
Do you share our belief that telehealth and data-driven remote care can provide more accessible, convenient, supportive and holistic approaches to diagnosing, treating and controlling symptoms for GI conditions?
Do you thrive in a rapidly evolving, fast-paced environment requiring creativity, resourcefulness, high energy and an ability to adapt quickly?
If so, you could be a perfect fit for our team of like-minded professionals who share a common mission and passion for helping others and a desire to build an industry-leading company.
Oshi Health is revolutionizing GI care with a digital clinic model that provides easy, convenient access to an integrated and multidisciplinary care team that takes a holistic approach to diagnosing, managing and treating digestive health conditions. We take time to get to know each patient, develop a personalized, whole-person care plan that includes identification of symptom triggers and prescription of evidence-based interventions, including medications, dietary changes, and mental health support. Our care is delivered virtually through our app, secure messaging and telehealth visits. When in-person diagnostics or procedures are needed, we take a concierge approach and coordinate access, care and follow up with local providers.
We are seeking a Clinical Operations Licensing & Credentialing Specialist to lead our licensing and payer credentialing process as we scale our clinical care team across multiple states and payers. This role will report to the VP of Clinical Operations and work closely with our Director of Clinical Operations and Director of Strategy and Operations. This is a remote position.
What you’ll do:
- Regulatory Knowledge & Expertise: Serve as the subject matter expert and leader of credentialing and licensing with high attention to alert leadership of essential changes and required actions to ensure compliance across all state and federal requirements. Identify opportunities to leverage essential leaders and partners as well as update protocols to ensure compliance and alignment across key stakeholders.
- Clinician Roster Management: Develop and maintain a detailed database of required state licenses, certifications, and credentials of each provider in the Oshi Health Roster. The maintenance of the provider roster would include identification and flagging of gaps or potential risks, monitoring and addressing of relevant timelines associated with expirations/renewals (ensuring recertification occurs timely), and ensuring all appropriate documentation is filed with appropriate entities.
- Cross-Licensure Oversight: Partner with relevant vendors and/or providers to identify and manage key cross-licensure opportunities as we grow and scale our clinician team. This includes serving as the project manager to drive forward an internal process including communication with providers as well as regular reporting to the Clinical and Strategy Operations teams on licensure and credentialing statuses and timelines to align the launch and implementation of new business.
- 3rd Party Relationships: Own relationship-management with relevant 3rd party partnerships including but not limited to licensure & credentialing partners, state boards, and health plan payer. This may include providing necessary resources, and deliverables to ensure effective management of the provider roster to mitigate any risks associated with growth and expansion as well as to drive efficiencies in process.
- Clinician Hiring Process: Take the lead in provider onboarding as it relates to primary source verification, initial credentialing, and other key requirements to inform key decisions on hiring and onboarding. Serve as the initial and final reviewer of the provider/applicant’s licensing and medical credentialing applications to ensure compliance with each entity’s specific requirements and standards including state and federal regulatory requirements.
Qualities we’re looking for in candidates:
- Ready to roll up your sleeves and serve the mission and goals wherever there is a need
- At least 3+ years of experience tracking and managing medical licenses and payer credentialing of large-scale clinical teams across multiple payers. Ideally, across multiple states
- Subject Matter Expert with deep understanding of medical licensure and credentialing nuances across payers and states, with keen attention to risk management
- Relate your work to the key team and company goals / OKRs
- Collaboration comes naturally, you can clearly articulate your ideas and build alignment within your team and across the organization
- Ability to put pen to paper to distill complex licensing and credentialing concepts into clear frameworks, operational flows, training materials and KPIs for measurement
- Proactive in thought and naturally considers impact of all decisions to mitigate risks and drive outcomes
- Strong organizational and project management skills – Ability to oversee, manage and effectively prioritize multiple projects across a team to drive growth and expansion
- Centered on customer satisfaction and demonstrated ability to manage 3rd party relationships and meet essential deadlines
What you’ll bring to the team:
- An avid project manager, who has the ability to successfully manage multiple key stakeholders and firmly yet thoughtfully drive towards essential deadlines
- Ability to describe (verbal & written) step-by step processes and provide insight into common potential challenges as well as recommended solutions to successfully navigate the credentialing process
- Lover of details and demonstrated ability to independently manage multiple key stakeholders needs through effective communication, data driven decision making, and timeliness of updates is essential
- Proactive in identifying operational and workflow gaps and swiftly building and documenting efficient solutions in alignment with relevant stakeholders to ensure decisioning is well-informed
- Thrive in an entrepreneurial environment, comfortable with ambiguity and confident in making decisions with a passion for challenging the status quo in healthcare
- Operate with high integrity and accountability for results
- Proficiency in Google Workspace (previously Google Suite), especially Google Sheets
- Bachelor Degree preferably in healthcare administration or related field
- CPCS and/or PESC certifications a plus
Oshi Health’s Core Values:
- Go For It
- Do the Right Thing
- Be Direct & Open
- Learn & Improve
- Thrive on Diversity
Oshi Health is an equal opportunity employer that is committed to creating a diverse work environment. To do that, we champion a workplace where each and every person is treated with dignity and respect and is valued for their unique perspective and contributions.
Oshi Health’s policy is to maintain a working environment that encourages mutual respect, promotes harmonious and congenial relationships between employees, and is free from all forms of discrimination and harassment of any employee (or applicant for employment or service provider) by anyone, including supervisors, co-workers, vendors, or clients. Harassment and discrimination in any manner or form is expressly prohibited. There is no tolerance for discrimination or unequal treatment of any kind on the basis of race, color, religion, creed, gender, sex, sexual orientation, gender identity or expression, pregnancy, sexual and reproductive health decisions, national origin, age, disability, genetic information, marital status or civil partnership/union status, familial status, military or veteran status, predisposition or carrier status, domestic violence victim status, alienage or citizenship status, unemployment status, sexual violence or stalking victim status, caregiver status, or any other characteristic protected by law.
This practice applies to all terms, conditions and privileges of employment including, but not limited to, recruitment, selection, promotion, demotion, transfer, layoff, rehire, termination of employment, development and training, compensation, benefits and retirement.
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Location: Philadelphia, PA
Job date: Thu, 16 Sep 2021 07:17:27 GMT