Credentialing Specialist

Element Science • Fulltime • San Carlos, CA, USA, United States • $57k - $62.70k / year • 3m ago

CREDENTIALING SPECIALIST

THE COMPANY:

Element Science, Inc. is a medical device and digital health company focused on developing solutions at the intersection of clinical-grade wearables, machine learning algorithms, and lifesaving therapies in order to address leading causes of death and hospitalization in patients with heart disease, primarily as they transition from the hospital-to-home. By putting the needs of patients and physicians first, our personalized digital devices, which are designed for function, comfort, and ease-of-use, aim to redefine the paradigm of care for these patients. Our first product, a wearable patch defibrillator, is initially targeted at treating the more than 500,000 patients in the US with an elevated temporary risk of potentially experiencing a lethal heart rhythm. Based in San Francisco, our funders include Third Rock Ventures, Google Ventures, Deerfield Healthcare, Qiming Venture Partners USA, Cormorant Asset Management, and Invus Opportunities.

SUMMARY OF ROLE:

The Credentialing Specialist will work closely with Sr. Director of Payer Relations to ensure the securing of in network status with targeted insurance companies, third party payers, and other healthcare reimbursement entities. This includes the obtaining and submitting of approved payer contracts and credentialing applications. The position requires strong analytical skills, in-depth knowledge of the healthcare landscape, and the ability to navigate credentialing as well as contracting requirements.

RESPONSIBILITIES:

Initiate the credentialing and contracting process for the targeted payers
Maintain a database of all payer contracts, credentialing applications and related supporting documents
Initiates all credentialing applications with insurance carriers
Coordinate the review of payer contracts by the Element Science Contract Review team to assist in the timely execution of contracts.
Track the renewals of any payer contracts and any recredentialing dates to assure that company maintains in-network status with payers
Help monitor any contract performance standards and ensure all obligations are met
Assist in providing support and guidance to internal stakeholders regarding payer contract terms and requirements.
Maintains strict adherence to company policies and confidentiality agreements
Organizes and prioritizes daily work to ensure all responsibilities are kept current

QUALIFICATIONS:

A proven track record of at least 2-5 years working on credentialing and payer contracting process preferably in the medical device industry.
Bachelor’s degree or equivalent professional experience.
Have previous experience working with 3^rd party Credentialing Verification Organizations (CVO’s) and data companies such as EviCore and CAQH.
Strong analytical skills, in-depth knowledge of the healthcare landscape, and the ability to navigate credentialing as well as contracting requirements.
Strength in providing excellence in customer service.
Exceptional capacity for follow-through, organization, and meticulous attention to detail.
Substantial experience in documentation, interpreting credentialing instructions and payer contract language.

BENEFITS:

Element Science offers a very competitive salary and benefits package including, but not limited to:

Stock Options
90% employer-paid medical, dental, and vision insurance
Company-paid Basic Life Insurance
401(k) retirement plan (Traditional and Roth)
Competitive Paid Time Off
Paid Holidays
FSA (Flexible Spending Accounts)
HSA (Health Savings Account)
Employee Assistance Program through PEO

The salary for this position will be based on experience and qualifications within an established pay range.

Pay range: $57,000 - $62,700 + Annual Bonus

Element Science is an Equal Opportunity Employer. All candidates will be evaluated on the basis of their qualifications for the job in question. We do not base our employment decision on an employee’s or applicant’s race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors prohibited by local, state, or federal law.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. We are not able to sponsor individuals for employment visas for this job.

At this time, we are unable to offer relocation assistance at Element Science.