Lead payer credentialing and re-credentialing processes for healthcare providers.
Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
Oversee payer enrollments, manage the payer credentialing team, maintain data accuracy, and streamline provider onboarding.
Theoria Medical provides comprehensive medical group and technology solutions to serve patients across the care continuum, with an emphasis on post-acute and primary care. They aim to improve the quality of care delivered, refine facility processes, and enhance critical relationships, serving facilities across the United States.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Ensuring providers are credentialed in a timely manner by monitoring the submission process.
Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
Communicating with payors and conducting regular reviews to validate internal credentialing data.
Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.
Responsible for the strategic oversight, execution, and continuous improvement of all provider credentialing, re-credentialing, payer enrollment, contracting coordination, and licensure activities across all AnswersNow business entities.
Ensures that providers and groups are credentialed, contracted, and licensed accurately and on time so that services may be delivered, billed, and reimbursed without delay.
Leads the credentialing team, manages external vendors, partners cross-functionally with RCM, growth, operations, scheduling, and technology teams, and delivers clear, data-driven reporting to executive leadership.
AnswersNow is innovating autism therapy by making it more immediate, accessible, and effective for families. Their remote team allows for a flexible work-from-home environment, providing client support without the need to report on-site.
Own the end-to-end cycle of credentialing applications for new and existing providers under our contracts, ensuring all requirements are met for successful enrollment.
Assist in building NCQA compliant ongoing monitoring and delegation programs for the Nourish network of RDs.
Support efforts to streamline existing credentialing processes by providing suggestions for automation or new tools, optimizing individual steps, and ensuring smooth workflows.
Nourish is on a mission to improve people’s health by making it easy to eat well. They are building an AI-native, patient-friendly healthcare system centered on nutrition that improves outcomes, lowers costs, and helps people live healthier, longer lives. Nourish launched three years ago, are live in all 50 states, and already have thousands of dietitians and hundreds of thousands of patients on the platform.
Manage all aspects of provider licensing, credentialing, and payer enrollment.
Coordinate end-to-end licensing workflows and maintain accurate records.
Act as a key liaison between clinicians, state boards, payers, and internal stakeholders.
They are committed to providing safe, discreet medication abortion treatment and offer a range of reproductive and sexual health care services. The in-house clinical care team composed of board-certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away.
Manage the full enrollment process for Medicare and Medicaid across applicable states.
Prepare, complete, and submit all required enrollment applications and documentation.
Track application status and follow up with agencies to drive timely approvals.
BetterHelp aims to improve mental health and make mental healthcare accessible. They are the world’s largest online therapy service with over 30,000 licensed therapists, and they value employee mental health, investing in their team’s well-being and professional development.
Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Collect, analyze, and interpret clinical, operational, and financial data to assess payer performance and trends.
Maintain SOPs, payer playbooks, internal how-to guides, and reference materials.
Translate front-line payer knowledge into scalable process improvements.
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. They partner with over 450 companies and provide care for 10 million people.
Guiding applicants through the Virta enrollment process to answer questions and provide motivation.
Individually responsible for enrolling applicants and achieving individual and team based quarterly quotas.
Proactively thinks of ways to improve the enrollment process for patients and teammates and helps execute on those ideas with the team.
Virta Health aims to reverse metabolic disease in one billion people through technology, personalized nutrition, and virtual care delivery. They have raised over $350 million and partner with health plans, employers, and government organizations.
Manage fax and mail intake, process medical records requests, and complete insurance pre-authorizations.
Strengthen the operational foundation of our fast-growing digital sleep clinic by handling documentation and correspondence.
Collaborate closely with cross-functional teams in a tech-enabled care environment, contributing to accessible sleep health.
Dreem Health, managed by the Sunrise Group, is America's leading digital sleep clinic that's fixing the broken sleep care patient journey. They connect patients with sleep specialists through a straightforward telehealth platform, eliminating lengthy wait times and complicated in-lab testing.
Execute targeted outbound outreach via cold calling, email, and LinkedIn to US payers and managed care organizations.
Identify and engage key stakeholders within payer organizations, including leaders in Quality, Population Health, Care Management, SDOH, and Innovation.
Qualify inbound and outbound leads and book meetings for Enterprise Account Executives.
Blooming Health is an AI-powered Social Care Agent platform helping healthcare organizations turn social care solutions into real health outcomes for underserved populations. Our platform supports 1,000+ community organizations across 25 states, helping millions of members access the support they need to stay healthy.
Lead payer-focused marketing initiatives to improve reach and pipeline performance.
Build understanding of payer partners' business models to inform GTM strategies.
Partner with marketing to elevate Maven’s relevance in the payer market.
Maven is the world's largest virtual clinic for women and families, dedicated to making healthcare accessible for all. With over 2,000 employers and health plans trusting their platform, Maven provides clinical, emotional, and financial support through innovative digital programs.
Act as the primary point of contact for new patients calling and emailing in.
Efficiently register and onboard a high volume of new patients.
Precisely verify patient insurance information to confirm active coverage and eligibility.
Form Health is a virtual obesity medicine clinic delivering multi-disciplinary evidence-based obesity treatment through telemedicine. Founded in 2019, Form Health is a venture-backed innovative startup with an experienced clinical and leadership team that values its employees.