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.
Lead and supervise credentialing support staff, ensuring quality, accuracy, and timely processing of credentialing and enrollment tasks.
Oversee provider credentialing, licensure, and internal enrollment with Medicare, Medicaid, Managed Care, and Commercial Plans.
Maintain provider rosters, monitor license and certification renewals, and ensure compliance with regulatory and internal standards.
At Better Life Partners, we provide what it takes to heal from addiction. Wherever. Whenever. By combining virtual and in-person counseling, community support, and medication access.
Facilitate all aspects of required medical licensure for clinical personnel.
Drive the licensing process in a proactive, organized and streamlined manner.
Collaborate with credentialing, onboarding, and clinical teams.
Talkiatry is a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist. They provide patients with the care they need and allow psychiatrists to focus on medicine with innovative technology and a human-centered philosophy.
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 licensing applications for new and existing providers across the U.S., ensuring all requirements are met for licenses to be approved.
Support efforts to streamline existing licensing processes by providing suggestions for automation or new tools, optimizing individual steps, and ensuring smooth workflows.
Develop SOPs (detailed guides) for new state or provider licensing, and own the implementation across the team.
Nourish aims to improve people’s health by making it easy to eat well. Nutrition-related chronic disease is the largest and most overlooked crisis in the world, and they are building an AI-native, patient-friendly healthcare system centered on nutrition. They are live in all 50 states, and have thousands of dietitians and hundreds of thousands of patients on the platform.
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.
Oversee the operations of the Imagine Pediatrics Onboarding, Credentialing, Licensing, and Enrollment Department. Develop and train on policies and procedures, workflows, and training documentation for the team. Manage Delegated Credentialing arrangements - implementation and audit – as well as ongoing Delegated partnerships with health plans.
Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs.
Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Establish and maintain licensing processes for Physicians, Nurses, and Licensed Mental Health providers.
Monitor progress and approval of submitted licenses ensuring timely completion.
Serve as the primary point of contact for all matters related to licensing.
TimelyCare provides virtual medical and mental health support. They foster a supportive team culture with a mission-driven purpose and are an equal opportunity employer.
The Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates. The Specialist will maintain accurate provider profiles in IntelliCred and CAQH.
Pediatrix Medical Group is one of the nation’s leading providers of specialized health care for women, babies and children since 1979.
Manage the day-to-day tasks of processing provider credentials, licenses and payor enrollment applications.
Work cross-functionally with many teams to guarantee the smooth running of operations.
Research, interpret, and evaluate information relevant to provider licensure and continuing medical education in the United States
CertifyOS is building the infrastructure that powers the next generation of provider data products, making healthcare more efficient, accessible, and innovative.
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.
Manage contracting and credentialing activities with insurance companies and Medicaid agencies. Oversee the provider enrollment, application, and credentialing process. Serve as the point of contact for contract negotiations and expedite approvals.
Amity Foundation is a safe place where people can change in an environment that fosters trust; where new values can be formed, responsibility developed, and lasting relationships built.