Delegated Credentialing Manager

What You’ll Be Doing: 

We’re looking for an experienced Delegated Credentialing Manager who is passionate about improving the landscape for mental healthcare. In this role, you’ll manage a team that oversees the credentialing process for healthcare providers and manage audits with payors to ensure compliance with industry standards and regulations. You’ll be part of a remote-friendly team, reporting directly into the Senior Manager of Credentialing & Enrollments. 

Your responsibilities will include: 

• Payor Audits: Develop and manage the payor audit process, ensuring compliance with payor requirements and conducting regular internal audits to maintain accuracy and compliance.
• Committee Leadership: Oversee the Delegated Credentialing Committee and lead monthly meetings to review and discuss the credentialing process, identify areas for improvement, and implement necessary changes.
• Monitor Average Time to Credential: Ensure that the average time it takes to credential a provider remains below 7 days by maintaining our relationship with our Certified Verification Organization (CVO) and liaising with our Implementation Team to ensure that operations continue to run smoothly.

Day-to-day Activities Include:

• Managing our Delegated Credentialing Specialists who are responsible for writing up issues files to present to committee and ongoing monitoring oversight. (35%)
• Serving as the primary point of contact on all payor communications related to delegated credentialing, including preliminary and annual audits. (25%)
• Overseeing our team of Offshore Assistants who do a preliminary check of the provider’s application prior to CVO submission. (20%)
• Maintaining regular communication with the CVO, sharing provider information and resolving any credentialing-related issues. (10%)
• Overseeing the Delegated Credentialing Committee Meetings, including leading the monthly meeting. (10%)

Salary range: $110,000 - $140,000

You’ll Be a Good Fit If: 

• Payor Audit & Relations Experience: You have a wealth of experience in managing payor audits, and you know how to prepare for them effectively and efficiently. Maintaining positive relationships with various payors and auditors comes to you easily because you are quick to understand their requirements and address their concerns.
• Regulatory Compliance Expertise: You have an in-depth knowledge of credentialing regulations and payor-specific requirements, and you know how to ensure that all processes comply with these regulations. You’re excited about continuously staying updated on industry trends and best practices so that the organization remains compliant and competitive.
• Team Management: You’ve previously managed and led a team of delegated credentialing specialists by fostering their productivity, performance, and professional development while creating a collaborative and efficient work environment.
• Technologically Savvy: You’re familiar with provider management software, and you’re not afraid to use a new system. You’re excited about using these tools to streamline the credentialing process and monitor provider data.
• Data-Driven Critical Thinking: You’re comfortable analyzing and interpreting data sets related to credentialing, using evidence-based insights to make informed decisions, driving process improvements, and optimizing compliance and efficiency.
• Confidentiality: You’re known for your high degree of professionalism and discretion when handling sensitive provider information and payor audit data.

If you don’t meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.