Credentialing Manager

🕒 June 10

🇺🇸 United States – Remote

💵 $70k - $77.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 46%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 153 days.
• Jobs at this company usually fill in 34 days.
• Reposted once.

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Charlie Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

💰 Seed Round on 2020-06

Healthcare • Healthcare Insurance • Wellness

Charlie Health is a provider of personalized intensive therapy and virtual Intensive Outpatient Programs (IOP) targeting mental health challenges. They cater to both teens and adults, offering a comprehensive treatment approach that includes therapies such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and art and music therapy, among others. The company aims to provide immediate access and flexible scheduling to accommodate patients' needs, focusing on various conditions like anxiety, depression, self-harm, and substance use disorders. Charlie Health emphasizes measurable outcomes and connection with peers to foster long-term healing, with services available in as little as 24 hours.

📋 Description

• Lead, manage, and develop a team of 5+ credentialing specialists and own team KPIs • Own and operate the delegated credentialing program end-to-end • Manage provider onboarding and primary source verification • Maintain NCQA-aligned standards • Lead the internal credentialing committee, present cases, maintain minutes, and manage approvals • Manage payor and internal audits for NCQA and delegated credentialing compliance • Set long-term credentialing strategy and expand delegated credentialing statuses across payors • Build and maintain a centralized credentialing source of truth for payor-specific requirements • Partner with Commercial Strategy, RevOps, RCM, and Compliance • Troubleshoot problem payors and credentialing-related denials • Implement process improvements, automation, and AI-enabled workflows • Oversee payor and Medicaid enrollment across group and individual submissions, tracking applications in Salesforce

🎯 Requirements

• 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, 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 • Process improvement experience 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 • Native or bilingual English proficiency • Familiarity with and willingness to use Google Suite, Slack, Zoom, Dropbox, and Salesforce

🏖️ Benefits

• Performance bonus • Potential stock options • Comprehensive benefits for all full-time, exempt employees

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