Credentialing Manager

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🔥 6 minutes ago

🐻 Alaska, California, +9 more states – Remote

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

💵 $70k - $77.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Charlie Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

💰 Seed Round on 2020-06

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, 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

🎯 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 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

🏖️ Benefits

• comprehensive benefits to all full-time, exempt employees