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Associate Credentialing Team Lead

RemoteUnited States only
Published
Role
Operations
Experience
Mid
Employment
Full-time
Company size
Enterprise
$65k–$75k/yr
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Open to US only. Set where you work from to check your eligibility.

No BS summary

Credentialing operations lead with 3+ years in provider credentialing and 1+ year leading credentialing committee meetings. Must know NCQA credentialing standards, accreditation requirements, primary source verification, and healthcare or behavioral health credentialing.

What you'll do

  • Coordinate and facilitate scheduled Credentialing Committee meetings, ad hoc meetings, and appeal committee meetings, including agenda development, case preparation, meeting logistics, and documentation.
  • Review flagged provider credentialing and recredentialing files for completeness, accuracy, and readiness for committee review.
  • Ensure committee decisions are accurately documented and communicated to appropriate stakeholders.
  • Monitor timelines for flagged credentialing cases to ensure review within regulatory, accreditation, payer, and organizational requirements.
  • Serve as the primary escalation point for complex provider credentialing cases requiring committee review, additional investigation, or appeal.
  • Provide day-to-day guidance, coaching, and support to credentialing specialists and contractors.
  • Review credentialing files for accuracy, completeness, and compliance with internal policies, NCQA standards, and payer requirements.
  • Maintain committee minutes and file documentation in accordance with credentialing policy.
  • Develop and maintain standardized committee workflows, checklists, and documentation processes.
  • Support onboarding, training, and ongoing development of credentialing team members.
  • Promote consistency and quality across credentialing committee operations.
  • Partner with Provider Operations, Compliance, Leadership, Legal, and the Credentialing Department to support credentialing committee activities.
  • Coordinate with credentialing verification vendors and internal departments to resolve outstanding file deficiencies.
  • Communicate committee outcomes and credentialing decisions to appropriate operational teams.
  • Support delegated credentialing activities and respond to internal and external audit requests.
  • Serve as the Credentialing Team spokesperson in Credentialing Committee meetings and as the expert on credentialing processes in that setting.
  • Track committee metrics, including credentialing volumes, turnaround times, pending cases, and committee outcomes.
  • Identify workflow inefficiencies and recommend process improvements to enhance operational effectiveness and scalability.
  • Maintain credentialing committee records and documentation in accordance with regulatory, accreditation, and organizational requirements.
  • Support readiness for NCQA, payer, and regulatory audits by ensuring complete and accurate committee documentation.

What they require

  • 3+ years of experience in provider credentialing within a healthcare or behavioral health organization.
  • 1+ years of experience leading credentialing committee meetings.
  • Experience supporting credentialing committee processes and provider file review.
  • Working knowledge of NCQA credentialing standards, accreditation requirements, and primary source verification.
  • Experience mentoring or providing guidance to team members in an operational environment.
  • Strong organizational, analytical, problem-solving, and communication skills.
  • Experience working with credentialing software and provider data management systems.
  • Operational leadership and team collaboration.
  • Credentialing committee coordination and governance.
  • Knowledge of NCQA standards and regulatory compliance.
  • Quality assurance and documentation management.
  • Process improvement and workflow optimization.
  • Strong attention to detail and organizational skills.
  • Effective communication and stakeholder management.
  • Ability to prioritize multiple deadlines in a fast-paced, growth-oriented environment.
  • Critical thinking and sound judgment when reviewing provider credentialing cases.
  • Preferred: Experience in a national or multi-state provider organization.
  • Preferred: Familiarity with delegated credentialing programs and payer credentialing requirements.
  • Preferred: Experience supporting accreditation or regulatory audits.
  • Preferred: Bachelor's degree or equivalent combination of education and relevant experience.

Benefits

  • Remote work with regular in-person bonding experiences sponsored by the company.
  • Travel expenses are covered for required in-person collaboration.
  • Reasonable accommodations are made for those under unique circumstances who cannot travel.
  • Competitive compensation.
  • Eligible for a performance bonus.
  • Holistic perks program, including free therapy, employee wellness, and more.
  • Excellent health, dental, and vision coverage.
  • 401k benefits with employer matching contribution.
  • The chance to build something that changes lives and that people love.
  • Any piece of hardware or software that will make you happy and productive.
  • An awesome community of co-workers.
  • Sustainable work/life balance.

virtual counceling and therapy service company

🇺🇸 United StatesMental HealthEnterprisebetterhelp.com

Details

Apply routeGreenhouse
$65k–$75k/yr