Credentialing Specialist

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

📋 Description

• Supervise assigned credentialing tasks for a designated payer portfolio, which includes readiness assessments, continuous compliance oversight, regular reporting, and yearly audits.

• Stay updated on NCQA guidelines, state regulations, and accreditation changes; evaluate their operational effects and execute necessary compliance modifications.

• Prepare for and conduct pre-delegation and annual credentialing audits; create and monitor corrective action plans until resolved.

• Maintain thorough, audit-ready credentialing documentation, incorporating primary source verification, Credentialing Committee records, and logs of adverse actions.

• Generate regular deliverables for delegated partners and payers, such as provider lists, audit documentation, and credentialing activity summaries.

• Track average credentialing timelines, 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 information and reconcile internal records with delegated payer lists.

• Act as a point of contact for payer-related communications regarding delegated credentialing activities, audits, provider records, and follow-up tasks.

• Assist in the implementation of new delegated credentialing agreements, including establishing processes and controls to meet contractual obligations.

• Facilitate Credentialing Committee meetings, which involve preparation, execution, minute-taking, training materials, record-keeping, and follow-up actions.

• Oversee credentialing for Nurse Practitioners, including reviewing applications, performing primary source verification, ensuring committee readiness, submitting to payers, and tracking status.

• Aid in the credentialing of group practice providers by coordinating documentation, addressing application discrepancies, monitoring timelines, and keeping provider records precise.

⛳️ Requirements

• 2–5 years of experience in credentialing and enrollment, with a minimum of 2 years dedicated specifically to delegated credentialing.

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

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

• Proactive team member who excels in a multi-tasking setting and can adapt priorities as needed.

• Exceptional attention to detail, strong organizational skills, and proficient documentation abilities.

• Excellent written and verbal communication skills.

• Background in high-growth or tech-enabled healthcare is preferred; experience in behavioral health is advantageous.

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

• Candidates must be authorized to work in the U.S. without requiring company sponsorship now or in the future.

🏝️ Benefits

• Competitive salary and stock options.

• Fully-covered medical and dental premiums for you and your family, plus optional insurance offerings.

• Complimentary and substantial Tava mental health benefit.

• Monthly HSA contributions for eligible enrolled employees.

• Generous paid time off and holidays.

• Paid parental leave.

• 401(k) retirement plan.

• Weekly company-sponsored lunches via DoorDash and a personal DashPass subscription.

• Chance to make a significant impact within a high-growth, mission-driven organization.