Delegated Credentialing Specialist

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

📋 Description

• Supervise credentialing tasks assigned to a specific payer portfolio, which includes readiness evaluations, ongoing compliance monitoring, recurring reporting, and annual audits.

• Keep abreast of NCQA guidance, state regulations, and accreditation updates; evaluate operational impacts and implement necessary compliance modifications.

• Prepare for and lead pre-delegation and annual credentialing audits in line with NCQA and payer-specific requirements.

• Create and monitor corrective action plans until resolution is achieved.

• Maintain thorough, audit-ready credentialing documentation, including primary source verification, Credentialing Committee records, and adverse action logs.

• Generate regular deliverables for delegated partners and payers, such as provider rosters, audit materials, and credentialing activity reports.

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

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

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

• Aid in the implementation of new delegated credentialing agreements along with related processes and controls.

• Lead operations for Credentialing Committee meetings, which includes preparation, execution, and follow-up.

• Keep minutes of Credentialing Committee meetings, training materials, committee records, and follow-up items organized.

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

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

⛳️ Requirements

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

• Certified Provider Credentialing Specialist (CPCS) certification from 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 effectively.

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

• Exceptional written and verbal communication skills.

• Experience in high-growth/tech-enabled healthcare settings is preferred.

• Experience in behavioral health is an advantage.

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

• Must be authorized to work in the U.S. without the need for 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.

• Free and generous 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-paid lunch via DoorDash.

• Personal DashPass subscription.

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