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Director, Credentialing
@Spring Health
[Hiring] Director, Credentialing @Spring Health
Apr 01, 2025 - Spring Health is hiring a remote Director, Credentialing. đź’¸ Salary: $164,900 - $214,450. đź“ŤLocation: USA.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
The Director of Credentialing and Compliance will own the credentialing function, reporting to the Sr. Director, Network Growth Operations, and partnering with various teams.
- Oversee all aspects of the credentialing/recredentialing of practitioners in alignment with State, Federal, and NCQA standards.
- Build and oversee Payer enrollment processes, ensuring timely and accurate enrollment of providers.
- Manage and ensure quality related to credentialing operations.
- Work cross-functionally with Product, Health Plan Operations, Medical Affairs, and Compliance teams.
- Act as the Subject Matter Expert (SME) for credentialing processes and systems.
- Establish, implement, and monitor performance goals, metrics, and processes for the Credentialing department.
- Lead the implementation of new credentialing tools and systems.
- Maintain familiarity with network adequacy and provider network standards.
- Manage provider data by conducting regular audits.
- Collaborate closely with the Revenue Cycle Management (RCM) team.
- Provide strong leadership and development opportunities to the credentialing team.
Qualifications
- 10+ years of experience in healthcare credentialing, compliance, and provider network management.
- Proven leadership experience managing credentialing teams of 10+ individuals.
- Deep knowledge of NCQA accreditation standards.
- Ability to define and drive execution at scale.
- Strong process improvement skills.
- Experience in payer relations and delegated credentialing.
- Exceptional analytical and problem-solving skills.
- Strong collaboration and stakeholder management skills.
- Excellent communication skills.
- Commitment to fostering a high-performance culture.
Requirements
- NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred.
- CPHQ, CPPS, CPHRM, or similar certification preferred.
- Experience leading contractual, regulatory, and accreditation survey preparation.
- Experience selecting, implementing, and managing new software systems.
Benefits
- Health, Dental, Vision benefits start on your first day.
- Employer sponsored 401(k) match of up to 2% for retirement planning.
- A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers.
- Competitive paid time off policies including vacation, sick leave, and company holidays.
- Parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents after 6 months tenure.
- Access to Noom, a weight management program.
- Access to fertility care support through Carrot, with reimbursement for related expenses.
- Access to Wellhub, connecting employees to fitness, mindfulness, nutrition, and sleep options.
- Access to BrightHorizons for sponsored child care, back-up care, and elder care.
- Up to $1,000 Professional Development Reimbursement a year.
- $200 per year donation matching to support your favorite causes.
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| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
All others
All others
|
Salary
đź’¸
$164,900 - $214,450
|
Remote
Location
USA
|
|
Job Type
unspecified
|
Posted
Apr 01, 2025
|
️
| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
