Credentialing Specialist

🔥 6 minutes ago

🏈 Alabama, Arizona, +19 more states – Remote

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⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 10%

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Tava Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

👥 HR Tech

💰 $10M Series A on 2021-12

Healthcare • Healthcare Insurance • HR Tech

Tava Health is a company that partners with employers to provide accessible and affordable mental healthcare to employees. They offer a comprehensive approach that differs from traditional Employee Assistance Programs by providing quick access to licensed therapists for both short-term needs and ongoing care for persistent mental health issues. Tava Health's network of vetted therapists can be accessed by employees within a short time frame, enhancing employee engagement and reducing employer healthcare costs. The company is integrated with employer health plans, offering evidence-based therapies to improve mental health outcomes and workplace productivity.

📋 Description

• Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits • Monitor NCQA guidance, state regulations, and accreditation updates; assess operational impact and implement compliance changes • Prepare for and facilitate pre-delegation and annual credentialing audits according to NCQA and payer-specific requirements • Develop and track corrective action plans through resolution • Maintain complete, audit-ready credentialing records, including primary source verification, Credentialing Committee documentation, and adverse action logs • Prepare recurring deliverables for delegated partners and payers, including provider rosters, audit materials, and credentialing activity reports • Monitor average time to credential, identify delays, manage follow-up, and escalate issues as needed • Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and reconcile internal records against delegated payer rosters • Serve as a point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items • Support implementation of new delegated credentialing agreements, processes, and controls • Lead Credentialing Committee meeting preparation, execution, minutes, records, training materials, and follow-up • Lead credentialing for Nurse Practitioners, including application review, primary source verification, committee readiness, payer submissions, follow-up, and status tracking • Support credentialing for group practice providers by coordinating documentation, resolving application gaps, monitoring timelines, and maintaining accurate provider records

🎯 Requirements

• 2–5 years of credentialing and enrollment experience, including at least 2 years specifically focused on delegated credentialing • Certified Provider Credentialing Specialist (CPCS) certification through NAMSS • Ability to manage multiple payer relationships and responsibilities with minimal oversight • Self-motivated team player who thrives in a multi-tasking environment and can adjust priorities • High attention to detail, strong organization, and excellent documentation skills • Outstanding written and verbal communication • High-growth/tech-enabled healthcare background preferred • Behavioral health experience is a plus • Familiarity with CAQH, NPDB, PECOS, state licensing resources, credentialing software, and payer rostering tools • Must have authorization to work in the United States without company sponsorship now or in the future

🏖️ Benefits

• Competitive salary and stock options • Fully-covered medical and dental premiums for you and your family • Voluntary insurance options • Free, generous Tava mental health benefit • Monthly HSA contributions for qualifying enrolled employees • Generous PTO and paid holidays • Paid parental leave • 401(k) retirement plan • Weekly company-paid lunch via DoorDash • Personal DashPass subscription • Opportunity to make a meaningful impact at a high-growth, mission-driven company

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