Credentialing Manager
Alma
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $110,000 - $130,000 per year
Job Level
Mid-LevelSenior
About the role
- Audit & NCQA Compliance Ownership: Serve as the subject matter expert and primary liaison for all insurance payer audits related to delegated credentialing agreements
- Implement and maintain NCQA standards and requirements across all credentialing policies and procedures to uphold accreditation readiness and quality assurance
- Design, implement, and maintain the Compliance Scorecard and KPIs for credentialing and RCM, demonstrating measurable improvement year-over-year
- Ensure the organization is prepared for annual audits by developing a playbook and ensuring improvements based on any previous Corrective Action Plans (CAPs)
- Work with Legal and Compliance to monitor changes in payer, state, and federal laws and rapidly update internal policies and Standard Operating Procedures (SOPs) accordingly
- Lead compliance efforts within the RCM division, focusing on the regulatory intersections between credentialing, enrollment, and claims processing
- Identify and eliminate bottlenecks in the Credentialing and RCM workflows, specifically targeting root causes of claim denials and credentialing delays to improve the Clean Claim Rate
- Oversee the performance of any Credentials Verification Organization (CVO) partners and internal support partners to ensure their work meets NCQA and organizational quality standards
- Ensure annual required trainings are completed for all RCM and Credentialing staff
- Facilitate and support the Credentialing Committee, ensuring committee decisions are documented and adhered to in alignment with all policies and procedures
- Act as a hands-on individual contributor when necessary, diving into operational details, troubleshooting issues, and executing complex tasks to drive continuous improvement
Requirements
- Robust Credentialing Leadership: 6+ years of progressive experience in healthcare credentialing, with a significant portion dedicated to managing delegated functions
- Delegated Credentialing Expertise: Deep, demonstrated experience supporting and managing delegated credentialing agreements, including familiarity with pre- and post-delegation audit requirements and payer submission processes
- NCQA Proficiency: Deep understanding and practical experience with NCQA standards and their application to both credentialing files and quality committee structure
- RCM Compliance & Behavioral Health Knowledge: Strong working knowledge of the Revenue Cycle Management process and the regulatory nuances specific to mental/behavioral health services (e.g., medical necessity documentation)
- Compliance Measurement: Proven experience establishing, monitoring, and reporting compliance KPIs and scorecards
- Project Management & Organization: Exceptional organizational and project management skills with a demonstrated ability to manage complex, detailed, and timeline-driven compliance projects independently
Benefits
- We’re a remote-first company
- Health insurance plans through Aetna (medical and dental) and MetLife (vision), including FSA and HSA plans
- 401K plan (ADP)
- Monthly therapy and wellness stipends
- Monthly co-working space membership stipend
- Monthly work-from-home stipend
- Financial wellness benefits through Northstar
- Pet discount program through United Pet Care
- Financial perks and rewards through BenefitHub
- EAP access through Aetna
- One-time home office stipend to set up your home office
- Comprehensive parental leave plans
- 12 paid holidays and 1 Alma Give Back Day
- Flexible PTO
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialingNCQA standardscompliance KPIsRevenue Cycle Managementdelegated credentialing agreementsaudit requirementsmedical necessity documentationCorrective Action Plansperformance monitoringproject management
Soft skills
leadershiporganizational skillscommunicationproblem-solvingattention to detailcontinuous improvementcollaborationindependent management