Responsibilities
- Provide day-to-day guidance, training, and support to credentialing associates
- Design, document, and implement scalable credentialing workflows and standard operating procedures (SOPs).
- Identify and troubleshoot inefficiencies in credentialing and recredentialing processes.
- Collaborate cross-functionally to ensure credentialing processes integrate smoothly with clinical, compliance, and billing teams.
- Manage relationship with CVO (Credentialing Verification Organization), Verifiable
- Maintain accurate and up-to-date provider information in internal databases and Verifiable
- Track application statuses, credentialing deadlines, and recredentialing timelines to ensure timely completion.
- Analyze and update processes to improve timelines
- Liaise with CVO to resolve any issues or delays in the credentialing process.
- Develop and maintain dashboards, reports, and trackers related to provider credentialing and compliance.
- Analyze data to identify trends, delays, or potential risks in credentialing timelines.
- Provide regular updates to leadership on key metrics and process improvements.
Requirements
- 3+ years of experience in healthcare credentialing, operations, or administrative support in a payer or provider setting.
- 1+ years experience supervising credentialing associates
- Operational leadership and accountability
- Strong understanding of NCQA credentialing requirements and best practices.
- Proficiency with Microsoft Excel/Google Sheets and experience with CRM or credentialing software (e.g., CAQH, Verifable).
- Excellent organizational and communication skills, with the ability to manage multiple tasks and deadlines.
- Experience in behavioral health or mental health provider credentialing.
- Ability to work in the US, to travel to our San Jose, California offices up to three times per year and to an additional company offsite.
Certifications & Qualifications
- NCQA credentialing requirements
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