Manage initial credentialing and re-credentialing applications for physicians and mid-level providers across multiple U.S. states.
Complete and maintain CAQH ProView profiles, ensuring all provider data is accurate, current, and attestation-ready.
Submit and track payer enrollment applications with commercial insurance companies, Medicare, and Medicaid programs.
AMS Solutions is a leading medical billing and revenue cycle management company serving healthcare practices across the United States. They specialize in helping physicians maximize their revenue through expert billing, coding, credentialing, and practice management services.
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.
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.
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.
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.
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.
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.
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.
Serve as the primary contact for CM/UM programs and operational questions related to the MyCare Platform.
Build relationships with provider offices through outreach and timely follow-up, resolving issues within defined turnaround times.
Educate providers on submission requirements, documentation, timelines, and available CM/UM resources.
Personify Health created a personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while improving health outcomes.
Own & Manage Provider Relationships : Serve as the primary point of contact for provider primary care partners.
Support Provider Recruitment Activities as Product SME : Partner with CA GTM team to execute a provider onboarding and training best practices.
Optimize Provider Success & Retention : Implement and oversee a structured engagement plan to ensure providers maximize their use of our platform.
Counterpart Health is transforming healthcare with its AI-enabled primary care tool, Counterpart Assistant, that supports early diagnosis and management of chronic conditions. They drive value-based care at the speed of software with a team of value-based care and technology experts.