Credentialing Manager

🔥 il y a 19 heures

🐻 Alaska, California, +9 états de plus – Distant

🐻 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 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

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Charlie Health

Site WebLinkedInTous les Emplois

501 - 1000 employés

⚕️ Assurance santé

🧘 Bien-être

💰 Seed Round en 2020-06

Healthcare Insurance • Wellness

Charlie Health est un prestataire de services de santé mentale spécialisé dans les programmes de soins intensifs ambulatoires (IOP) virtuels conçus pour les adolescents et les adultes. L'entreprise propose des solutions thérapeutiques personnalisées et flexibles pour une large gamme de problèmes de santé mentale tels que l'anxiété, la dépression, les traumatismes, l'automutilation et les troubles liés à l'usage de substances. Charlie Health met l'accent sur l'accessibilité et le soin immédiat avec des traitements débutant sous 24 heures et des horaires flexibles. À travers diverses méthodes thérapeutiques, dont la thérapie cognitivo-comportementale (CBT) et la thérapie comportementale dialectique (DBT), Charlie Health vise à obtenir des résultats exceptionnels et à favoriser la guérison à long terme de ses clients. Accréditée par la Joint Commission, Charlie Health s'engage à maintenir des standards élevés en matière de sécurité et de qualité des soins.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• comprehensive benefits to all full-time, exempt employees