Managing the credentialing, payer enrollment, and provider onboarding processes for physicians and advanced practice providers.
Ensuring providers are credentialed, enrolled, and maintained with commercial and government payers in a timely and accurate manner.
Maintaining provider records, monitoring credentialing deadlines, and coordinating with payers and providers.
Modena Health (MH) and Modena Allergy & Asthma (MAA) are leading and rapidly growing medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona, and ambitious plans for national expansion. They are physician-led, hospitality-focused, and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Manage day-to-day credentialing and re-credentialing workflows for Tia’s provider network.
Support medical licensing workflows for MDs, DOs, NPs, PAs, and RNs across multiple states, including tracking requirements, deadlines and renewals.
Track onboarding progress and help ensure providers are licensed, credentialed, enrolled, and compliant before go-live.
Tia is building a new model for women’s healthcare, one that treats women as whole people. They are a Series D, venture-backed company trusted by more than 120,000 women across four markets, building a culture of excellence in people, process, and product.
Processes initial and reappointment assignments for hospitals and surgical centers.
Maintains accurate records of providers' credentials, licensure, and continuing education.
Updates credentialing databases and ensures compliance with accreditation standards.
US Anesthesia Partners is a national healthcare organization specializing in anesthesia services. The company is an equal opportunity employer focused on clinical excellence and supporting its staff of medical professionals and administrative employees.
Enrolls providers new to Privia with all commercial health plans specific to the market.
Updates and maintains provider enrollment status in credentialing system, CredentialStream.
Performs follow up with health plans according to designated timeline, until Provider is PAR.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Privia Health consists of scalable cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Processes applications for credentialing and privileging, both initial and reappointment, adhering to policies and procedures related to legal, state, OHSU, DNV, TJC, and NCQA guidelines.
Investigates and validates discrepancies and adverse information from applications and primary source verifications, communicating with credentialing contacts ensuring timely and accurate completion.
Maintains practitioner credential files, containing confidential peer review information, and updates credentialing databases with detailed documentation during all steps, from receipt of application to processing completion.
OHSU is Oregon's only public academic health center, focused on patient care, research, and training the next generation of healthcare professionals. As Portland's largest employer, OHSU provides opportunities for learning and advancement within its system of hospitals and clinics.
Research, interpret, and evaluate information relevant to provider licensure and continuing medical education in the United States.
Complete applications for provider credential, licensure or payor enrollment on behalf of Certify customers.
Validate and authenticate information updated on the credentialing, licensing platform and ensure 100% accuracy.
CertifyOS is building the data infrastructure that powers modern healthcare. Their API-first platform automates provider licensing, enrollment, credentialing, and network monitoring by connecting directly to hundreds of primary data sources. The company values authenticity, accountability, collaboration, results, and openness to feedback.
Manage end-to-end delegated credentialing operations across an assigned portfolio of payors.
Prepare, coordinate, and execute both pre-delegation and annual credentialing audits.
Build and deliver reporting packages for submission to delegated entities & payors.
Grow Therapy is a company that serves as a trusted partner for therapists growing their practice, and patients accessing high-quality care. They are powered by technology as a three-sided marketplace that empowers providers, augments insurance payors, and serves patients with over ten thousand therapists and hundreds of thousands of clients across the country.
Manage end-to-end provider licensing, including application preparation, submission, and follow-up across multiple states.
Coordinate and track licensing timelines, proactively following up to avoid delays.
Assist with the development and maintenance of workflows and processes for licensing operations.
Midi Health is a virtual care clinic focused on helping women navigate perimenopause, menopause, and other midlife health challenges. At Midi, they’re building the future of women’s healthcare and growing quickly.
Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations.
Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes.
Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain.
Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. They offer a variety of health insurance products and services as well as providing information and tools to help individuals make better health decisions. At AZ Blue, they have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.
Respond to questions from primary care clinicians on a HIPAA-compliant platform.
Ensure recommendations are educational, cost-effective, and evidence-based.
Participate in product interviews and voluntary projects.
RubiconMD is a web-based electronic consultation platform connecting primary care clinicians with medical specialists. They aim to improve patient care and reduce unnecessary referrals by providing same-day insights from a network of specialists.
Verify patient insurance coverage, eligibility, and benefits prior to services.
Obtain required prior authorizations from payers for services, procedures, or medications.
Monitor and track pending authorizations; follow up to prevent delays.
Prompt is revolutionizing healthcare with modern software for rehab therapy businesses. As the fastest-growing company in the therapy EMR space, Prompt is setting a new standard in healthcare technology with a team of exceptionally talented individuals.
Develop product requirements supporting CMS Medicare FFS provider data standards including NPI validation, taxonomy classification and provider file maintenance aligned to HIPAA requirements.
Ensure provider configuration capabilities align with CMS enrollment, credentialing and revalidation mandates including PECOS data alignment and provider directory accuracy obligations.
Translate CMS provider data regulatory updates into structured product requirements and backlog items while partnering with implementation teams to identify and remediate compliance gaps.
HealthEdge provides an integrated platform of solutions that enables health plans to converge their data and harness insights to improve outcomes. The company has a team of visionary, empathetic people who believe technology should remove friction from healthcare and operate with agility as the regulatory landscape evolves.
Execute day-to-day provider enrollment, credentialing, and licensing tasks under guidance.
Input, maintain, and update provider data across databases and internal systems.
Review and process enrollment applications, supporting documentation, and status updates.
Allara is a women’s health provider that specializes in expert, longitudinal care that supports women through every life stage. Allara makes expert healthcare accessible by connecting patients with multidisciplinary care teams and is trusted by over 60,000 women nationwide.