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
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.
Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage.
Ensure credentialing policies and documentation meet payer and regulatory requirements.
Build and continuously improve credentialing infrastructure, including SOPs and policies/procedures.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the healthcare system. They partner with health plans, providers, and community organizations to deliver culturally competent care; they are scaling rapidly across states and populations.
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.
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.
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.
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.
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.
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.
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.
Support providers and patients by managing administrative tasks.
Ensure compliance, coordination, and continuity of care.
Manage documentation related to tele-mental health services.
Valera Health is at the forefront of tele-mental health, committed to delivering compassionate mental health care that is accessible and affordable. The company employs a comprehensive care approach, combining therapy and medication management with overall wellness promotion to ensure patients are supported.
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.
Translates patients’ medical records into standardized codes for diagnoses and treatments.
Ensures compliance with legal, regulatory, and organizational standards.
Manages records to ensures claims are processed correctly and on time.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. They are an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada.
Strengthening the connection between the patient and their primary care physician/medical practice staff, as well as improving the patient’s health and well-being.
Engaging patients and helping them navigate their care, solve their healthcare issues, and improves communication with their medical practice.
Assisting the patient in achieving better health outcomes by addressing their questions and concerns, connecting them with the medical practice.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Their goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Greet patients in a friendly, outgoing manner and ensure 360 communication.
Verify and explain insurance benefits and collect co-pays accurately.
Assist in clinic performance and maintain supplies.
Team Rehab is a therapist-owned network of outpatient clinics across Michigan, Illinois, Indiana, Wisconsin, and Georgia. Since our first clinic opened in 2001, we’ve built a reputation for excellent outcomes, exceptional patient satisfaction, and a workplace where therapists love to work.
Obtains authorizations from Insurance companies for scheduled tests/procedures.
Interprets patient medical records and reviews cases with the insurance nurse reviewer.
Accurately enters information into multiple computer programs and insurance websites.
CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas. With six hospitals, 5 ERs, and over 80 clinics, CoxHealth has earned honors for workplace excellence and employs over 14,000 employees.
Accurately assign ICD-10-CM, CPT, and HCPCS codes for Behavioral Health and SUD services.
Review clinical documentation to ensure coding accuracy and compliance.
Stay current with coding updates, payer policies, and regulatory changes.
Steadfast Health is dedicated to setting a new standard of care for substance use disorder (SUD) treatment. They are rapidly growing and building a dedicated team of professionals, focused on low-barrier, high-quality care accessible to all.
Provide accurate information on health plan benefits, eligibility, and claims.
Handle inbound/outbound calls and respond to email inquiries.
Deliver an exceptional customer service experience to members and providers.
Evry Health's mission is to bring humanity to health insurance. Their high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. Evry Health is the major medical division of Globe Life (NYSE:GL).