Credentialing & Enrollment Specialist @ Imagine Pediatrics

Who We Are

We are Imagine Pediatrics, a devoted and compassionate, multi-disciplinary pediatrician-led medical group that is creating a world where every child with complex medical conditions gets the care and support they deserve. Energized by our mission to reimagine pediatric health care, we are pioneering virtual-first care services that include care coordination and around-the-clock access to complex-care clinicians from home. We don’t replace a child’s existing care team. Instead, we collaborate to deliver continuous support to kids, so they can spend less time in the hospital and more time thriving at home and in their communities.

Every day we boldly challenge old approaches and seek out new and better ways to improve the health and lives of children with medical complexity. In partnership with caregivers, providers, and health plans, we break down the barriers that stand between families and quality care for their children. We know we can’t solve every challenge in the lives of these kids, but we can work tirelessly to give them, their families, and other caregivers the help and relief they need, right when they need it. We know a better approach to pediatric health care is within reach, and we are committed to seizing it today.

What We Live By

We’re guided by our five core values:

Children first.We put the best interests of children above all. We are uncompromising in our commitment to improving the lives of children and families by bringing the best care to them.
Earn trust.We cherish the trusting relationships we build with the children and families we serve, our partners, and each other. We seek first to understand and speak honestly.
Innovate today. We refuse to accept the way things have always been done. Children and families are waiting for our help and their bravery demands that we relentlessly challenge assumptions to develop new approaches.
Embrace humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to learn and grow stronger.
One team, diverse perspectives. We work alongside families as one team towards a shared purpose. We champion diversity and acknowledge the contributions of others.

What You’ll Do 

As a Credentialing Specialist at Imagine Pediatrics, you will play a critical role in supporting our behavioral health service line and enabling our providers to make sure every child with complex medical conditions gets the care and support they deserve. You will:

Reviews and screens initial and re-enrollment credentialing applications for completeness, accuracy, and compliance with federal and state regulations, guidelines, policies, and standards.

Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and Imagine Pediatrics criteria.

Manage the end-to-end process of acquiring new licenses for behavioral health staff.

Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to Credentialing & Enrollment Manager for sound decision making in accordance with Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.

Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.

Enters, updates, and maintains data from provider applications into credentialing database (Medallion), focusing on accuracy, and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.

Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.

Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.

Communicates clearly with providers, their liaisons, medical leadership and administration, as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.

Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.

Performs miscellaneous job-related duties as assigned.

Prepares and submits payer enrollment applications directly to payers.

Gather any additional data and/or documents from providers to facilitate enrollments.

What You Bring & How You Qualify

3-5+ years of experience handling payer credentialing

Extensive experience credentialing and enrolling behavioral health professionals (LCSW, LMFT, LPC, etc.)

Extensive experience with Medicaid in a multi-state organization. Telehealth experience strongly preferred

Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.

Working knowledge of clinical operations and procedures.

Ability to use independent judgment and to manage and impart confidential information.

Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.

Demonstrated advanced working knowledge of Microsoft Word and Excel.

Advanced skills in computerized spreadsheeting and database management.

Willingness to grow and lean all components of the healthcare revenue cycle.

What We Offer (Benefits + Perks)

We offer a competitive compensation package in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary.

We provide these additional benefits and perks:

Full medical, dental, and vision insurance

Healthcare and Dependent Care FSA

401(k) with 4% match, vested 100% from day one

Life insurance at 1x annual salary

20 days PTO + 10 Company Holidays & 2 Floating Holidays

Paid parental leave

Additional benefits to be detailed in offer

We Value Diversity, Equity, Inclusion and Belonging

We believe that creating a world where every child with complex medical conditions gets the care and support they deserve requires a diverse team with diverse perspectives. We’re proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

6 month growth

1 year growth

2 year growth