Spring Health · 1 day ago
Associate Director, Credentialing and Network Compliance
United States
Full-time
Remote
Senior Level
$127K/yr - $158K/yr
7+ years exp
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Responsibilities
Oversee all aspects of the credentialing/recredentialing of practitioners in alignment with State, Federal, and NCQA standards, as well as contracted health plan directives, including pre-delegation and annual audits of all credentialing delegated entities.
Manage and ensure quality related to credentialing operations, providing oversight to support the continued growth and development of the organization.
Work cross-functionally with Product, Health Plan Operations, Medical Affairs, and Compliance teams to pull and analyze reports, ensuring that credentialing data aligns with organizational goals and regulatory standards.
Act as the Subject Matter Expert (SME) for credentialing processes and systems, providing guidance and support to internal stakeholders to ensure compliance and efficiency.
Establish, implement, and monitor performance goals, metrics, and processes for the Credentialing department. Prepare and maintain various reports, data, and summaries of credentialing activities.
Lead the implementation of new credentialing tools and systems to enhance operational efficiency and compliance.
Oversee provider enrollment processes, including the submission, tracking and follow-up of applications, to ensure timely and accurate enrollment of providers with Medicare, Medicaid, and managed care programs.
Maintain familiarity with network adequacy and provider network standards to ensure compliance with regulatory and contractual requirements. Manage provider data by conducting regular audits to ensure the accuracy and integrity of provider information in credentialing databases and systems, collaborating data management teams to develop and implement data quality initiatives, automate data entry processes, and resolve data discrepancies efficiently.
Collaborate closely with the Revenue Cycle Management (RCM) team to ensure that provider credentialing and enrollment statuses are up-to-date, facilitating successful claims processing and reimbursement.
Provide strong leadership and development opportunities to the credentialing team, fostering a collaborative and high-performance culture.
Qualification
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Required
Minimum of 7 years of experience in a quality-focused role in healthcare, with a strong emphasis on provider credentialing, provider data integrity, and managing provider network adequacy within a health plan setting
Demonstrated experience in developing policy and procedure documentation
Knowledge of NCQA Accreditation requirements and demonstrated experience preparing for and leading accreditation and regulatory site surveys (NCQA, TJC, CMS, etc.)
Knowledge of medical credentialing and privileging procedures and standards
Experience in project management and partnering with cross-functional teams
Data-driven and analytical by nature with demonstrated skills in gathering, analyzing, and interpreting data in Google Sheets/MS Excel
Excellent oral and written communication skills—ability to fluently tell a compelling clinical, compliance, or business story with data
A thoughtful and collaborative approach to problem-solving
Humility, resourcefulness, empathy, and professionalism
Demonstrated passion for, and understanding of, mental health and the broader U.S. healthcare system
Preferred
NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS)
CPHQ, CPPS, CPHRM, or similar certification
Experience leading contractual, regulatory and accreditation survey preparation (TJC, NCQA, Payers, etc.) and net new quality accreditation efforts
Experience selecting, implementing, and managing new software systems
Benefits
Health, Dental, Vision benefits start on your first day at Spring Health. You and your dependents also receive an individual One Medical account which is valued at $199/year per user. HSA and FSA plans are also available.
Employer sponsored 401(k) match of up to 2%
A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.
Generous paid time off, 10 sick days, 12 paid holidays throughout the year, and a 1 month sabbatical leave granted at your 4 year anniversary
We offer parental leave up to 18 weeks, depending on your eligibility including tenure and medical situation.
Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses.
Access to Wellhub, an on-demand virtual benefit that provides wellbeing coaching, and budget management.
Up to $1,000 Professional Development Reimbursement a year.
$200 per year donation matching to support your favorite causes.
Company
Spring Health
Spring Health provides mental health solution for employers and health plans.
1,001-5,000 employees
H1B Sponsorship
Spring Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (5)
2022 (7)
2021 (2)
2020 (3)
Funding
Current Stage
Late StageTotal Funding
$466.5MKey Investors
Generation Investment ManagementKinnevikTiger Global Management
2024-07-31Series E· $100M
2023-04-12Series D· $71M
2021-09-16Series C· $190M
Leadership Team
April Koh
Co-Founder & CEO
Adam Chekroud
Co-Founder, President
Recent News
Company data provided by crunchbase
