Credentialing Manager

Job not on LinkedIn

🔥 1 minute ago

🗽 New York – Remote

🗽 New York – Remote

💵 $80k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

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Talkspace

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2011

💼 Consulting

🏥 Healthcare

🛍️ eCommerce

Consulting • Healthcare • eCommerce

Talkspace is an online therapy platform that provides accessible mental health care through licensed therapists and psychiatric providers. Users can engage in therapy through text, audio, and video sessions, as well as receive medication management when needed. Talkspace aims to make therapy convenient and affordable by partnering with major insurance providers and offering various treatment options for individuals, couples, and teens dealing with a range of mental health issues.

📋 Description

• Lead and manage a small group of Credentialing Interns, Associates, and Specialists, overseeing job assignments, performance reviews, and professional development while ensuring alignment with organizational goals. • Approve timesheets, provide mentorship, and offer strategic support to optimize team performance and ensure operational success. • Streamline operational processes related to credentialing. • Prepare and present comprehensive credentialing packets for the Credentialing Committee, including flagged file reviews, logistics coordination, and credentialing KPI reporting. • Liaise with the Credentialing Verification Organization and Credentialing Supervisor to ensure timely completion, downloading, and uploading of files and accurate system updates. • Collaborate with credentialing stakeholders and the CVO to improve outreach, resolve inconsistencies, and facilitate weekly meetings. • Initiate and manage timely provider re-credentialing, including quality and complaint data review and provider documentation. • Identify non-engaging, zero-caseload providers and process administrative terminations when unresponsive. • Coordinate completion and scheduling of clinician re-credentialing cycles with the CVO. • Support delegated credentialing relationships with Enterprise clients and Account Management. • Provide regular network update reports and monthly roster reports to Enterprise clients. • Submit and track pre-delegation enrollment packets and outcomes. • Conduct regular CVO audits and quarterly internal Credentialing Program audits. • Provide data for Enterprise client audits. • Oversee review of credentialed licenses and support ongoing monitoring documentation and reporting. • Continuously review and refine credentialing workflows and implement best practices. • Perform other related duties as assigned.

🎯 Requirements

• Bachelor’s Degree required (Master’s Degree preferred) or 7+ years of professional experience in credentialing or a related field. • 4+ years of professional experience in a credentialing, compliance, or healthcare operations role, with proven experience in team leadership and process management. • Strong background in managing credentialing operations, including experience working with Credentialing Verification Organizations (CVOs) and handling delegated credentialing agreements. • Familiar with NCQA standards and guidelines as well as policy and contract review to ensure compliance with said standards. • Demonstrated ability to manage cross-functional teams, lead projects, and streamline workflows to optimize efficiency. • Excellent communication, organizational, and problem-solving skills, with a strong focus on collaboration with both internal and external stakeholders. • Experience in conducting audits, maintaining compliance with regulatory standards, and implementing process improvements. • Familiarity with credentialing software and systems, as well as proficiency in reporting on credentialing metrics. • Proficient with Mac devices, Excel, Word, Google Suite (sheets, docs).

🏖️ Benefits

• Comprehensive Medical, Dental and Vision plans • Pre-tax benefits: HSA/ FSA • 401k Retirement Savings Program with matching up to 4% • Voluntary benefits including disability, basic life or pet insurance, etc. • Monthly Wellness Stipend to promote mental and physical self-care • Flexible PTO and Remote First Environment • Regular team events, including Wellness Workshops and Team Building Events • Free access to Talkspace products for you and one household member, as well as access to a friends and family discount!