Credentialing Operations Lead

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November 21

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Talkiatry

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Healthcare Insurance • Telecommunications • Wellness

Talkiatry is a virtual mental health care provider offering online psychiatry services. It specializes in the diagnosis and treatment of various mental health conditions including anxiety, ADHD, bipolar disorder, depression, OCD, PTSD, and more. With a large team of expert psychiatrists, Talkiatry provides virtual visits that are covered by insurance, making mental health care more accessible. Patients can complete an online assessment to connect with a psychiatrist and receive personalized treatment plans, which may include medication and supportive therapy. Talkiatry aims to ease access to mental health care through flexible scheduling and personalized care, supporting over 175,000 people to date.

501 - 1000 employees

⚕️ Healthcare Insurance

📡 Telecommunications

🧘 Wellness

📋 Description

• Supervise Credentialing Specialists’ execution of daily credentialing tasks, ensuring workflows and file progression align with defined SLAs and onboarding timelines. • Serve as a subject matter expert on credentialing workflows, helping ensure accuracy, consistency, and adherence to SOPs across the team. • Act as the first point of triage for provider delays, documentation gaps, or platform blockers, escalating issues to the Credentialing Manager with relevant context and proposed resolution paths. • Monitor the PSV inbox and Booking Calendar daily to ensure accurate scheduling and appropriate specialist coverage; troubleshoot provider mis bookings and act as backup when needed. • Maintain accurate records in internal trackers and credentialing platforms, including applying start date changes, updating license information, and triggering appropriate workflows for new start dates, and recredentialing events. • Execute the Certificate of Insurance (COI) process for new providers, additional licenses, and terminations, including internal coordination and documentation. • Process credentialing and recredentialing files as needed, particularly during volume spikes or to cover for out-of-office specialists. • Track provider onboarding progress daily using internal trackers and dashboards, and flag risks, blockers, or process deviations to Credentialing leadership in a timely and structured manner. • Conduct quality review of all credentialing files to ensure alignment with documentation standards, audit readiness, and committee requirements. • Identify recurring workflow or documentation issues and escalate process gaps, training needs, or performance concerns to the Credentialing Manager. • Maintain and update operational SOPs, reference materials, and training content in collaboration with department leadership. • Provide day-to-day guidance and workflow support to Credentialing Specialists, helping troubleshoot execution issues and reinforcing adherence to SOPs and documentation standards. • Deliver workflow-based training and refreshers to Credentialing Specialists and support onboarding of new team members. • Execute monthly compliance monitoring activities, including NPDB re-enrollments, exclusion list checks (e.g., OIG, SAM), and certification audits. • Assist with preparing for quarterly delegated payor audits by compiling required documentation, reviewing credentialing packets to submit, and helping ensure audit readiness. • Collaborate with cross-functional partners (e.g., Compliance, HR, ClinOps, Payer Relations, Clinical) to collect and validate credentialing materials as needed by payors. • Track and maintain organized documentation logs for audit submissions, committee approvals, and supporting materials. • Assist in submitting audit materials and updating rosters and other audit-related reporting.

🎯 Requirements

• 3+ years of experience in healthcare credentialing, with a strong understanding of end-to-end workflows. • Strong working knowledge of NCQA standards and documentation expectations. • Ability to interpret and apply accreditation standards, regulatory requirements, and internal credentialing policies. • Demonstrated ability to execute high-volume credentialing processes with precision and attention to detail. • Experience supporting peers through workflow guidance, training sessions, and quality assurance efforts in a high-volume, SLA-driven environment. • Experience with credentialing platforms (e.g., Medallion, Verifiable) and multi-state provider onboarding processes. • Excellent organizational skills and attention to detail, with the ability to manage multiple workstreams concurrently. • Strong interpersonal and communication skills, with the ability to coach peers. • Polished verbal and written communication skills, with the professionalism required to engage with clinical leaders and represent credentialing in committee settings. • Comfort operating in a fast-paced, execution-focused environment where priorities may shift frequently. • Bachelor’s degree preferred.

🏖️ Benefits

• medical, dental, vision, effective day 1 of employment • 401K with match • generous PTO plus paid holidays • paid parental leave • and more!