Credentialing Specialist

This is a fully remote position, open to applicants in Alabama, +20 more states.

📋 Description

• Supervise assigned credentialing activities for a specific payer portfolio, which includes readiness reviews, continuous compliance monitoring, regular reporting, and annual audits.

• Keep track of NCQA guidance, state regulations, and updates on accreditation; evaluate operational effects and implement necessary compliance adjustments.

• Organize and lead pre-delegation and annual credentialing audits in accordance with NCQA and payer-specific standards.

• Create and monitor corrective action plans until resolution.

• Ensure the maintenance of comprehensive, audit-ready credentialing records, which encompass primary source verification, Credentialing Committee documentation, and logs of adverse actions.

• Prepare regular deliverables for delegated partners and payers, including provider rosters, audit documentation, and reports on credentialing activities.

• Track the average time required for credentialing, identify delays, manage follow-ups, and escalate issues when necessary.

• Collaborate with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other departments to ensure accurate provider data and reconcile internal records with delegated payer rosters.

• Act as a primary contact for payer communications concerning delegated credentialing activities, audits, provider records, and follow-up items.

• Assist in the implementation of new delegated credentialing agreements, processes, and controls.

• Lead the preparation, execution, documentation, training materials, and follow-up for Credentialing Committee meetings.

• Oversee credentialing for Nurse Practitioners, including application assessment, primary source verification, committee readiness, payer submissions, follow-ups, and status tracking.

• Facilitate credentialing for group practice providers by coordinating documentation, addressing application gaps, monitoring timelines, and maintaining accurate provider records.

⛳️ Requirements

• 2–5 years of experience in credentialing and enrollment, with at least 2 years dedicated to delegated credentialing.

• Certified Provider Credentialing Specialist (CPCS) certification through NAMSS.

• Capability to manage multiple payer relationships and responsibilities with minimal supervision.

• Self-driven team player who excels in a multitasking environment and can adapt priorities as needed.

• Strong attention to detail, excellent organizational skills, and outstanding documentation abilities.

• Exceptional written and verbal communication skills.

• Experience in a high-growth, tech-enabled healthcare setting is preferred.

• Background in behavioral health is advantageous.

• Familiarity with CAQH, NPDB, PECOS, state licensing resources, credentialing software, and payer rostering tools.

• Must possess authorization to work in the United States without company sponsorship now or in the future.

🏝️ Benefits

• Competitive salary and stock options.

• Fully-covered medical and dental premiums for you and your family.

• Voluntary insurance options available.

• Generous Tava mental health benefit at no cost.

• Monthly HSA contributions for eligible enrolled employees.

• Generous paid time off (PTO) and holidays.

• Paid parental leave.

• 401(k) retirement plan.

• Weekly company-paid lunch via DoorDash.

• Personal DashPass subscription.

• Opportunity to make a significant impact at a high-growth, mission-driven company.