Credentialing Manager

🕒 Junho 10

🐻 Alaska, California, +9 estados a mais – Remoto

🐻 Alaska – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🦞 Maine – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 Oregon – Remote 🍂 Massachusetts – Remote ❄️ Minnesota – Remote ☕ Washington – Remote

💵 $70.000 - $77.500 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

Candidatar-se

Encontrar Vagas Remotas Similares

Receber Emails de Vagas Remotas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Charlie Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

⚕️ Seguro de Saúde

🧘 Bem-estar

💰 Seed Round em 2020-06

Healthcare Insurance • Wellness

Charlie Health é um fornecedor de terapia intensiva personalizada e Programas Intensivos Ambulatoriais Virtuais (IOP) voltados para desafios de saúde mental. Eles atendem tanto adolescentes quanto adultos, oferecendo uma abordagem de tratamento abrangente que inclui terapias como Terapia Cognitivo-Comportamental (TCC), Terapia Comportamental Dialética (DBT) e terapia de arte e música, entre outras. A empresa visa fornecer acesso imediato e agendamento flexível para acomodar as necessidades dos pacientes, com foco em várias condições, como ansiedade, depressão, automutilação e transtornos por uso de substâncias. A Charlie Health enfatiza resultados mensuráveis e a conexão com os colegas para promover a cura a longo prazo, com serviços disponíveis em até 24 horas.

Descrição

• Lead, manage, and develop a team of 5+ credentialing specialists, owning team KPIs including enrollment turnaround times and applications submitted & approved • Own and operate the delegated credentialing program end-to-end, including provider onboarding, primary source verification, and maintaining NCQA-aligned standards • Lead the internal credentialing committee — presenting cases, maintaining meeting minutes, and managing approvals • Manage required payor audits and internal audits to ensure ongoing NCQA and delegated credentialing compliance • Set and drive long-term credentialing strategy, partnering with Commercial Strategy to expand delegated credentialing statuses across payors • Build and maintain a centralized “Credentialing Source of Truth” documenting payor-specific requirements (provisional credentialing, SLAs, backdating policies, etc.) • Partner with RevOps to align on KPIs and incentive structure, and with RCM to troubleshoot problem payors and credentialing-related denials • Identify and implement process improvements that increase team efficiency, including automation and AI-enabled workflows • Oversee day-to-day payor and Medicaid enrollment across group and individual submissions, ensuring timely, accurate, and compliant applications tracked in Salesforce

🎯 Requisitos

• Bachelor’s degree • 5+ years of experience in provider credentialing and/or health plan enrollment • Direct, hands-on experience owning or operating a delegated credentialing program is required, including primary source verification, credentialing committee operations, and NCQA standards • 2+ years of people management experience leading a credentialing or enrollment team preferred • Experience with both Medicaid and Commercial payor enrollment • Comfort with process improvement and a track record of leveraging automation and emerging technologies (including AI) to streamline operations • Strong cross-functional collaboration skills across RevOps, RCM, Commercial Strategy, and Compliance • Work authorized in the United States and native or bilingual English proficiency • Familiarity with and willingness to use cloud-based communication software — Google Suite, Slack, Zoom, Dropbox, Salesforce

🏖️ Benefícios

• comprehensive benefits to all full-time, exempt employees