Manage the end-to-end process of licensing applications.
Coordinate the initial credentialing and re-credentialing processes for licensed providers.
Maintain accurate and up-to-date records of all licensing and credentialing activities.
InStride Health delivers specialty anxiety and OCD care. They combine research-backed clinical care and innovative technology to eliminate the major problems with care today, and become the nation’s most trusted provider of pediatric anxiety and OCD care.
Define and execute the long-term vision for credentialing and enrollment, transitioning from manual processes to a tech-enabled, scalable operation.
Oversee the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers. Be the primary liaison for enterprise contract activations.
Lead the internal Credentialing Committee, presenting provider files and ensuring all primary source verifications (NPDB, OIG, SAM) are flawless.
Foodsmart is the leading telenutrition and foodcare solution, backed by a robust network of Registered Dietitians. Their platform is designed to foster healthier food choices, drive lasting behavior change, and deliver long-term health outcomes. At Foodsmart, their mission is to make nutritious food accessible and affordable for everyone, regardless of economic status.
Coordinate the end-to-end medical provider enrollment process.
Prepare and submit enrollment applications to Medicare, Medicaid, and other payers.
Maintain accurate provider data within internal systems to ensure consistency.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults through value-based care. Founded in 2021, it has quickly grown to serve over 200,000 seniors in 1,500+ communities across 32 states with a team of 1,000+ clinicians and other professionals.
Manage the standard credentialing review process for pharmacies.
Review exclusion lists to identify any excluded pharmacies.
Manage the development and maintenance of a credentialing database.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have solutions such as Capital Rx and Judi® which consolidates all claim administration-related workflows in one scalable, secure platform.
Own the end-to-end credentialing and payer enrollment process for behavioral health providers across multiple states.
Manage internal credentialing onboarding for newly hired providers by collecting and validating required documentation.
Design and maintain credentialing and enrollment tracking systems to monitor application status, renewal timeliness, and enrollment milestones as the company scales.
Willow Health aims to significantly improve the mental health care experience by expanding affordable access to high-quality, evidence-based intensive behavioral health care. The co-founding team of Cityblock and Oscar alums has two decades of collective experience working in healthcare and healthcare tech, and they are backed by Andreessen Horowitz.
Enrolling practitioners in health plans in a timely and effective fashion.
Monitoring progress and ensuring timeliness of enrollment completion.
Maintaining provider enrollment goals for all divisions.
Pediatrix Medical Group provides specialized health care for women, babies, and children. Since 1979, Pediatrix has grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services.
Execute non-delegated credentialing process for new and existing providers.
Serve as a point of contact for all insurance payor relationships.
Maintain accurate and up-to-date records of all credentialing activities.
Dental Care Alliance's mission is to advance the practice of dentistry by partnering with and supporting dental professionals to create a lifetime of healthy smiles. Headquartered in Sarasota, Florida, DCA supports over 400 allied practices and supports over 900 dentists across over 20 States.
Submit accurate enrollment applications to multiple public and private payers.
Manage enrollments across multiple states and provider types, ensuring timely follow-up.
Maintain up-to-date provider information in CAQH and resolve enrollment discrepancies.
Seven Starling is a virtual provider of women's behavioral health services, supporting every stage of motherhood. They combine therapy, peer support, and medication management with 94% of patients seeing improvement. They partner with OBGYN clinics and health plans to make care accessible.
Accurately translate patients’ medical records into standardized codes for diagnoses and treatments.
Ensure compliance with legal, regulatory, and organizational standards.
Ensure claims are processed correctly and on time.
Dignity Health Medical Foundation was established in 1993, and it is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation works together with physicians and providers throughout California to provide comprehensive health care services.
Lead advanced coding education for individual providers and large provider groups, utilizing remote methods such as E/M and Medicare Preventive services.
Design, implement, and lead specialty-specific documentation and coding training programs to address unique needs and challenges.
Monitor market trends and emerging issues related to documentation and coding, ensuring timely and relevant updates to training programs.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. Their platform is led by top industry talent and consists of scalable operations and end-to-end, cloud-based technology.
Accurately abstracts information from service documentation and assigns CPT, ICD-10, and HCPCS codes for billing compliance.
Reviews and resolves coding denials and completes charge sessions in assigned work queues in a timely manner.
Ensures documentation meets current EM Guidelines and specific payer rules before releasing codes for billing.
UofL Health is a fully integrated regional academic health system with hospitals, medical centers, and numerous physician practice locations. It has over 14,000 team members, including physicians and nurses, focused on delivering patient-centered care.
Supports coding and documentation quality assurance.
Performs internal audits to assess compliance and quality.
Researches coding, billing, and charging compliance issues.
Presbyterian Healthcare Services is dedicated to improving the health of patients, members, and communities. They are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group, employing nearly 14,000 individuals.
Responsible for the maintenance of relevant provider data for use in network development and contracting, provider relations, marketing & communications, contracting, and more.
This role will also work with other network development teams to support provider data management across the CommonSpirit enterprise, including contracting and credentialing teams, to complete requests and support network operations.
Collect, validate, and maintain provider data to support marketing, provider relations, network contracting, credentialing across all lines of business.
Dignity Health Management Services Organization (Dignity Health MSO) aims to establish a system-wide integrated physician-centric, full-service management service organization structure. They offer various management and business services, leveraging economies of scale and leading efforts in developing Dignity Health’s Medicaid population health care management pathways.