Delegated Credentialing Specialist
2 нед. назад
Страна неизвестнаRemote
compliance monitoringcredentialingaudit management
Manage delegated credentialing activities, payer audits, compliance reporting, and credentialing operations in mental health care.
О компании
- At Tava Health, we believe mental health care should be as accessible and stigma-free as a checkup. We're reimagining the entire experience: from how people find a therapist to how providers deliver care, so more individuals can get the support they need, when they need it.
- We’re a fast-growing team on a bold mission: to make high-quality mental health care available to everyone. If you’re passionate about using technology to solve meaningful problems and create lasting change, we’d love to meet you.
Обязанности
- The Delegated Credentialing Specialist owns the day-to-day execution of Tava Health’s delegated credentialing program across assigned payer relationships. This role manages payer audits, compliance reporting, audit-ready credentialing files, corrective action plans, provider-data reconciliation , and credentialing operations while partnering closely with internal teams and delegated entities. The role also supports day-to-day credentialing for Nurse Practitioners and group practices.
Требования
- 2–5 years of credentialing and enrollment experience, including at least 2 years specifically focused on delegated credentialing.
- Certified Provider Credentialing Specialist (CPCS) certification.
- Ability to manage multiple payer relationships and responsibilities with minimal oversight.
- Self-motivated team player who thrives in 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.
Другое
- 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 other accreditation updates; assess operational impact and implement necessary compliance changes.
- Prepare for and facilitate pre-delegation and annual credentialing audits in accordance with 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, such as provider rosters, audit materials, and credentialing activity reports.
- Monitor average time to credential and support targets by identifying delays, managing follow-up, and escalating issues as needed.
- Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and routinely reconcile internal records against delegated payer rosters.
- Serve as a reliable point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items.
- Support the implementation of new delegated credentialing agreements, including the processes and controls needed to fulfill contractual requirements.
- Serve as the operational lead for Credentialing Committee meetings in consultation with the Committee Chair, owning meeting preparation, execution, and follow-through.
- Curate and Maintain accurate Credentialing Committee meeting minutes, training materials, committee records, and follow-up items.
- NP and Group Practice Credentialing
- 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.
- Competitive salary and stock options (so you share in the company’s success).
- Fully-covered medical and dental premiums for you and your family, plus voluntary insurance options.
- Free, generous Tava mental health benefit — of course!
- 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 and a personal DashPass subscription.
- Opportunity to make a meaningful impact at a high-growth, mission-driven company.
- *For tax purposes, priority will be given to candidates living in states where we already have employees. These states are Alabama, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Idaho, Indiana, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, Utah, and Washington.
- Tava is unable to sponsor employment visas (such as the H-1B). Candidates must have authorization to work in the U.S. without company sponsorship now or in the future.
- All hiring activities at Tava Health are handled by company representatives using @ .com or @ us..com email addresses.
- Please beware of unauthorized recruiting communications requesting personal information. We never hire anyone without first completing a real-time, face-to-face interview (conducted by video or in-person), nor do we use encrypted instant messaging services like Signal. If you have questions regarding the authenticity of any outreach, please do not hesitate to use the chat feature on our website or contact us at careers@.com