Credentialing Manager

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

• Manage the execution of provider enrollment and credentialing applications for designated payers utilizing CAQH ProView, primary source verification, payer portal submissions, and follow-up procedures.

• Monitor application statuses and turnaround times, identifying delays or missing documentation as necessary.

• Ensure the maintenance of precise spreadsheets and dashboards, which include status logs, SLA trackers, and denial/resubmission records.

• Resolve issues related to missing NPI data, license discrepancies, payer portal challenges, and rejected applications.

• Leverage AI tools for repetitive tasks or research-intensive activities, such as drafting follow-up communications, summarizing payer requirements, and organizing data efficiently.

• Collaborate with credentialing and RCM teams to relay enrollment status and mitigate billing or provider go-live setbacks.

• Oversee contractors and vendors throughout credentialing and enrollment processes.

• Report directly to the Head of Provider Operations.

⛳️ Requirements

• Practical experience in provider credentialing and enrollment, encompassing CAQH, payer portals, license verification, and application submission and tracking.

• Proficient in Excel and spreadsheet management, including the use of formulas, filtering, pivot tables, and handling extensive trackers.

• Possess an ownership mentality; capable of identifying issues, investigating root causes, troubleshooting directly, enhancing SOPs, and independently driving resolutions.

• Comfortable working in a dynamic environment where processes are still being developed.

• Exceptional attention to detail, accuracy, and thoroughness.

• Familiarity with AI tools such as Claude, ChatGPT, or similar platforms is preferred.

• Previous experience credentialing telehealth providers, especially dietitians, therapists, or other non-physician specialties, is preferred.

• Knowledge of commercial and government payer portals, including Aetna, BCBS, Cigna, UHC, Humana, Medicare/Medicaid, is preferred.

• Experience in a high-growth startup or digital health company is preferred.

🏝️ Benefits

• Comprehensive health coverage including medical, dental, and vision plans.

• Flexible work hours and the possibility of remote work.

• Opportunities for professional development and career advancement.

• A supportive and innovative team environment.