Credentialing Manager

This is a fully remote position, open to applicants in New York.

📋 Description

• Take full ownership of the credentialing and recredentialing process for Allia’s national clinician network, encompassing provider applications, primary-source verification, CAQH, expirables, sanctions, exclusions, and audit-ready documentation.

• Facilitate the Credentialing Committee process by preparing necessary files, identifying exceptions, coordinating meetings, documenting outcomes, and tracking subsequent actions.

• Manage delegated credentialing operations, which include understanding payer requirements, handling delegation agreements, conducting audits, remediation efforts, and ensuring ongoing compliance.

• Collaborate with payer contracting teams on credentialing matters, provider participation, enrollment processes, roster management, and the implementation of new payer agreements.

• Oversee policies, workflows, reporting mechanisms, and SLAs related to credentialing status, risks, turnaround times, and provider participation across various payers.

• Enhance and automate credentialing workflows in partnership with Product, Engineering, Clinical, Compliance, and Operations teams.

⛳️ Requirements

• Minimum of 5 years of experience in provider credentialing.

• In-depth understanding of CAQH, primary-source verification, and NCQA standards.

• Hands-on experience with delegated credentialing and payer audits.

• Background in working with commercial health plans and provider enrollment processes.

• Exceptional attention to detail and capability to manage high-volume workflows effectively.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) plan with employer matching contributions.

• 20 days of paid time off in addition to company holidays.

• Paid sick leave.

• Paid parental leave.

• Support for professional development.

• Company-issued laptop and home-office equipment.

• Flexible, remote-first work environment.

• Equity participation.