Credentialing Manager
Lavender
Senior Operations Associate, Credentialing and Licensing
Headspace
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $79,200 - $110,000 per year
Job Level
Senior
About the role
- Oversee provider credentialing lifecycle, including primary source verification, initial credentialing, delegated roster submissions, non-delegated enrollments, and recredentialing
- Serve as a subject matter expert on NCQA credentialing standards and health plan variations, applying judgment and escalating to compliance/legal as needed
- Monitor and manage credentialing vendor performance against SLAs, holding vendors accountable and escalating performance issues
- Ensure credentialing processes meet NCQA requirements, contractual obligations, and are audit-ready
- Maintain accurate credentialing records, SOPs, and committee documentation
- Partner cross-functionally to align on credentialing workflows, escalations, and provider communications
- Assist with state licensing applications and renewals as needed
- Manage third-party vendor for primary source verification and support network scalability and compliance
Requirements
- 5+ years of experience in behavioral health provider credentialing
- Deep knowledge of NCQA credentialing standards and health plan interpretations
- Strong vendor management skills with experience monitoring SLAs and quality performance
- Demonstrated ability to make judgment calls on compliance and escalate appropriately
- Highly organized and detail-oriented, with excellent documentation skills
- Strong communication skills and ability to collaborate cross-functionally
- High level of accountability, ownership, and integrity
- Candidates must permanently reside in the US full-time
- Preferred: Experience with state licensing applications and renewals
- Preferred: Digital health and/or start-up experience
- Preferred: Familiarity with Availity, Medallion, and/or similar primary source verification platforms
