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Full-Time

Certified Provider Credentialing Specialist

Confirmed live in the last 24 hours

Circle Medical

Circle Medical

201-500 employees

Telehealth services for virtual medical consultations

Consumer Software
Healthcare

Compensation Overview

$64.5k - $65.7kAnnually

+ Vacation + Medical Benefits + Dental Benefits + Vision Benefits + 401K + Education Reimbursement

Senior

Union City, NJ, USA

Hybrid position; requires in-office presence.

Category
Risk & Compliance
Legal & Compliance
Required Skills
Communications
Management
Requirements
  • 5+ years of credentialing experience with medical staff
  • CPCS or CPMSM certification
  • Proficiency in using credentialing software and databases.
  • The ability to think logically and analytically to problem-solve on a daily basis.
  • Have emotional intelligence and the ability to possess self-awareness and base decisions on your analysis of facts.
  • Strong time management and prioritization skills to make sound business decisions.
  • In-depth knowledge of the clinical, healthcare, and telemedicine standards, regulations, and medical credentialing and privileging procedures and standards.
  • Excellent communication skills; written, verbal, as well as auditory
  • Familiarity with healthcare, telehealth, and regulatory terminology.
  • Professional integrity to adhere to professional confidentiality standards in accordance with HIPAA, legal, ethical, and company policies
  • Critical thinking skills to exercise sound independent judgment and discretion in applying departmental policies and procedures while handling confidential medical staff, risk management, and peer review information.
Responsibilities
  • Track credentialing and licensing status for our providers
  • Implement and manage an effective credentialing and licensure program
  • Lead and monitor all credentialing, re-credentialing, and provider enrollment processes
  • Maintain a database of provider certifications and renewal dates
  • Confirm that provider credentials match the requirements of their job
  • Help full-time providers apply for or renew credentials which may include finding test dates and locations, identifying CME requirements, or submitting applications and payments on their behalf
  • Ensure staff coordination and administration of the credentialing and licensing process for certified staff and providers
  • Assist with cross-state licensure process
  • Review, analyze and create practitioner credentialing applications, privileging forms, and standardized communications in an effort to improve communication and compliance
  • Identify and communicate all concerns regarding practitioner credentialing and enrollment to appropriate parties; follow up when necessary to ensure affected parties and departments are notified of concerns in an appropriate time frame
  • Monitor for provider sanctions and collaborate with appropriate teams to action accordingly
  • Develop and review company policies
  • Communicate with government agencies
  • Other duties as assigned by management

Circle Medical provides telehealth services that allow individuals to access healthcare without needing to visit a physical clinic. The company connects patients with licensed healthcare providers through secure video chat, enabling virtual consultations for general medical issues, annual wellness exams, well-woman exams, and COVID-19 testing assessments. This approach enhances accessibility and is particularly useful during public health crises. Circle Medical generates revenue through insurance reimbursements and out-of-pocket payments, accepting all major insurance plans and offering a transparent billing process. The company targets tech-savvy individuals who value convenience and efficiency in their healthcare, aiming to make medical consultations more accessible and streamlined.

Company Stage

M&A

Total Funding

$38.6M

Headquarters

San Francisco, California

Founded

2015

Growth & Insights
Headcount

6 month growth

12%

1 year growth

3%

2 year growth

12%
Simplify Jobs

Simplify's Take

What believers are saying

  • The $14M investment from WELL Health Technologies provides financial stability and resources for further expansion and innovation.
  • The partnership with HEALWELL AI positions Circle Medical at the forefront of AI-driven healthcare solutions, potentially improving patient outcomes and operational efficiency.
  • The growing telehealth market offers significant growth opportunities, especially as more individuals seek convenient and remote healthcare options.

What critics are saying

  • The telehealth market is becoming increasingly competitive, requiring Circle Medical to continuously innovate to maintain its market position.
  • Dependence on insurance reimbursements could pose financial risks if there are changes in healthcare policies or insurance coverage.

What makes Circle Medical unique

  • Circle Medical leverages technology to provide convenient and accessible healthcare services, focusing on virtual appointments which sets it apart from traditional healthcare providers.
  • The integration of HEALWELL's AI platform with Circle Medical's EMR system enhances diagnostic accuracy and operational efficiency, providing a competitive edge.
  • Their acceptance of all major insurance plans and transparent billing process make healthcare more accessible and affordable for a broader demographic.