Manage provider enrollment & credentialing, leading the credentialing lifecycle for new and existing providers and practice locations.
Maintain provider data, ensuring CAQH profiles are complete, current, and accurately reflect provider credentials and practice information.
Optimize workflows, assessing current credentialing processes, identifying inefficiencies, and implementing improvements.
Sailor Health aims to solve the mental health crisis among older adults by connecting them, therapists, healthcare professionals, and insurance plans through their AI-native operating system. They are a growing company partnered with Medicare, offering affordable psychotherapy and striving to redefine aging with mental wellness.
Execute payer enrollment applications from credentialing approval through payer confirmation.
Coordinate CAQH profile maintenance and attestations in alignment with Medallion workflows and payer requirements.
Track enrollment status, follow up with payers, and escalate delays or issues to the Payer Enrollment Manager.
Spring Health aims to eliminate barriers to mental health by delivering the right care at the right time through their clinically validated technology, Precision Mental Healthcare. They partner with over 450 companies and are valued at $3.3 billion.
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
Maintain accurate provider profiles on CAQH, NPPES and any other applicable profiles
Complete credentialing applications to add current and new providers to commercial, Medicaid, and Medicare payers
Expressable is a virtual speech therapy practice with a mission to transform care delivery and expand access to high-quality services. They are passionate advocates of parent-focused intervention, serving thousands of clients since their inception in late 2019.
Oversee provider credentialing, provider licensing, payer contracting, and network expansion.
Lead end-to-end provider credentialing, provider licensing and recredentialing for MDs and NPs.
Manage relationships with credentialing and contracting vendors.
Sunrise Group is building the future of sleep health by combining innovative technology with expert care. They are a fast-growing team across the US and Europe, backed by more than $50M (€46M) from leading investors including Amazon’s Alexa Fund, Eurazeo, Kurma, and VIVES.
Manage end-to-end provider contracting and credentialing processes.
Maintain accurate and up-to-date provider records and documentation.
Assist with billing setup for newly credentialed providers.
Understood Care helps older adults by providing them with Medicare-covered patient advocacy services. They pair each person with a dedicated advocate who helps them navigate care, reduce costs, and make confident healthcare decisions.
Assisting with provider credentialing by collecting documentation, entering provider data, submitting required materials to the health plan, tracking completion, and updating internal records.
Maintaining and updating provider records from various sources in internal systems to ensure accuracy and completeness.
Supporting reporting requirements, including completing health plan reports on assigned schedules.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment in practicing medicine for providers. Powered by AI and Healthguides™, Guidehealth builds connections with patients and providers.
Lead and innovate within the Credentialing Department, driving operational excellence and compliance.
Provide strategic direction and oversight to Credentialing Specialists across all lines of business.
Develop and implement policies, procedures, and best practices for efficient and compliant operations.
Avesis has been providing essential ancillary benefit solutions since 1978, developing and administering best-in-class product choices and services. Today, their programs cover more than 8.5 million members throughout the country, striving for excellence with a focus on member satisfaction and client retention.
Manages the entire lifecycle of payer enrollment, credentialing, and re-enrollment of healthcare providers and facilities.
Maintains provider databases, ensuring accurate, timely submission of documentation to secure billing privileges and network participation.
Resolves claim denials, verifying insurance and performing billing related tasks to ensure timely and accurate reimbursement.
Plumas District Hospital (PDH) provides compassionate care with exceptional customer service. They are located in Quincy, California with a team that puts community first.
Manage licensure, certification, and credentialing for all applicable staff.
Track expiration dates and renewal requirements for licenses, certifications, DEA registrations, NPI numbers, and professional credentials.
Ensure compliance with state boards, CMS, accrediting organizations, and payer requirements.
Brighton/Suncrest Hospice aims to redefine hospice care by delivering outstanding service to patients. They achieve this by allocating resources to improve staff-to-patient ratios, increasing clinical visits, and lowering clinician caseloads. They are CHAP certified.
Lead, coach, and develop a team of Ops Associates.
Oversee the design and implementation of payor builds or process improvements.
Work closely with the Managers to identify process breakdowns and implement solutions.
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 and hundreds of thousands of clients across the country.
Lead day-to-day census, enrollment, eligibility, and Medicaid re-eligibility operations.
Develop, maintain, and enforce department policies, procedures, workflows, and monitoring routines.
Supervise, mentor, and develop staff while setting clear expectations and maintaining accountability for performance and quality.
Habitat Health aims to help older adults experience an independent and joyful aging journey. They provide clinical and social care through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with healthcare partners like Kaiser Permanente.
Submit, track, and manage all Community Supports, Enhanced Care Management and Community Health Worker authorizations/reauthorizations/referrals
Update Athena with authorization information and For Community Supports: add members to the outreach assignment tracker and ensure compliance with the 24-hour assignment standard
Ensure workflow alignment with referral/authorization processes and Conduct internal checks for compliance, quality assurance, and clinical alignment
Zócalo Health is a tech-driven provider built specifically for Latinos, by Latinos, developing a new approach to care designed around shared and lived experiences. Founded in 2021, they are backed by leading healthcare and social impact investors, aiming to improve the lives of communities that have dealt with generations of poor experiences.
Stand up and run the daily clinical operations for PIN/CHI delivery.
Define the care team structure, supervision ratios, and operating cadence.
Ensure billing-ready documentation is completed correctly every time. Partner with Compliance + RCM support to prevent leakage/denials caused by ops errors.
Carewell is focused on providing the most trusted and reputable retail source for caregiving products. They have been recognized as one of the fastest-growing companies in the US.
Manage provider onboarding processes and ensure a seamless experience.
Oversee compliance with clinician state licensure requirements.
Drive operational workflows and implement improvements within practice operations.
Jobgether uses an AI-powered matching process for job applications, ensuring quick and fair reviews. They share the top candidate shortlist with the hiring company, which manages the final decision and next steps.
Support the Medical Staff Services Credentialing team.
Collect, verify, and maintain accurate records within the Credentialing system.
Perform other administrative duties as assigned.
Cooper University Health Care is committed to providing extraordinary health care. Their professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.