Manager, Credentialing

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

📋 Description

• Directly oversee the daily operations of the credentialing function.

• Assist with delegated credentialing tasks for Health Plan Partners across all business lines.

• Manage the credentialing program for Altais affiliated entities, employed clinicians, clinical-service vendors, and MSO services clients.

• Administer credentialing functions to fulfill medical group, health plan, and NCQA requirements.

• Maintain, enhance, and execute credentialing processes and procedures that comply with regulations and standards.

• Monitor interdepartmental dependencies and evaluate their effects on providers and the Credentialing team.

• Offer leadership and mentorship to the credentialing team staff.

• Accurately and promptly process credentialing applications.

• Oversee the preparation of materials and documentation for external payer and governmental audits.

• Cultivate relationships with members of the health plan delegation oversight committee.

• Manage the initial and re-credentialing review conducted by the Clinical Advisory Group for exception physicians.

• Handle claims, appeals, and peer review physician documentation for the Clinical Advisory Group.

• Conduct audits of the credentialing database and verify provider information and database changes.

• Own the complete delegated credentialing process.

• Develop strategies, plans, and organizational priorities at the functional, market-level, and/or site level.

• Identify and resolve technical, operational, and organizational challenges beyond the team.

• Act as the Subject Matter Expert (SME) for business requirements for sPayer.

⛳️ Requirements

• Bachelor’s degree or equivalent to a four-year university degree, ideally in a healthcare-related field.

• A minimum of 5 years of professional experience in credentialing within a managed care environment is required.

• At least 1 year of management experience in Credentialing.

• Must be eligible to take the National Association Medical Staff Services (NAMSS) Certified Provider Credentialing Specialist exam within 18 months of employment.

• NAMSS Credentialing certification is preferred.

• External hires are required to pass a background check/drug screen.

🏝️ Benefits

• Comprehensive medical, vision, and dental insurance.

• 401k savings plan with company matching contributions.

• Flexible time off policy.

• Nine paid holidays.

• Competitive compensation package.

• Background check/drug screen required for external hires.