Credentialing Manager (FT Salaried-Remote) - Season

About the Role

As the Credentialing Manager, you will own all aspects of credentialing and will optimize the credentialing process at Season  You will be responsible for the credentialing and enrollment processes with commercial payers, as well as Medicare and Medicaid, and for overseeing the delegated credentialing process and related software. You will work with our clinical team as needed to align the credentialing and clinical onboarding processes. You will also collaborate with key stakeholders in the organization to communicate results and align on credentialing strategy. Initially, this role will have no direct reports, but management responsibilities may be added as the organization scales. This role will initially report to the Senior Director of Compliance.

About Season

Season Health is the only integrated clinical nutrition solution that drives engagement, outcomes and cost of care reduction across populations, powered by its food-as-medicine platform. With one of the largest networks of registered dietitians and a curated food market of national and local vendors, Season empowers individuals and their families to make informed, sustainable choices, measurably improving both health outcomes and quality of life. Learn more at www.seasonhealth.com 

Responsibilities

Credentialing Department Oversight

• Optimize the quality and efficiency of the Credentialing Department by developing and maintaining departmental SOPs. Identify opportunities for process improvement and standardization of departmental practices. Work with all levels of management and staff to implement changes that enhance the operational workflow. 
• Be the subject matter expert to create and share a culture of transparency on the credentialing process to relevant teams, both within the Credentialing Department, and at the individual provider level.
• Manage the credentialing process for all providers, in accordance with NCQA, URAC, CMS accreditation standards, and Federal and State Laws, including but not limited to: 
  • Coordinating with practice management, licensing agencies, insurance carriers, and other appropriate organizations to complete credentialing and re-credentialing applications.
  • Serving as the primary point-of-contact for day-to-day Provider Enrollment issues.
  • Ensuring all providers are accurately and timely loaded in all health plan systems through various vehicles including regular meetings, roster reconciliations, targeted problem resolution
  • Responding to and resolving unusual problems or delays in the enrollment process.  
  • Develop and manage the payor audit process, ensuring compliance with payor requirements and conducting regular internal audits to maintain accuracy and compliance.
  • Conduct on-going program evaluations and audits of data integrity.
  • Ensure contractual adherence in both operational and compliance SLAs, quality and timeliness standards.
• Serve as the Credentialing Administrator for the delegated credentialing process, including but not limited to:
  • Implementing and managing delegated credentialing process including use of Verifiable software and CVO services.
  • With assistance from counsel, negotiating delegated agreements with health plans.  
  • Working with the Compliance Officer, managing all annual delegated credentialing audits; responding to audit requests.
• Manage external service providers and tools (including but not limited to Verifiable)
• Assess the allocation of resources, ensuring a balanced workload for enrollment staff.
• Take on management responsibility for the credentialing team as we scale.

Coordinate with Billing and Revenue Cycle Processes

• Identify and track revenue cycle related issues impacting health plan payments
• Challenge payor agenda to drive process improvement on the front and back-end - including delegation.
• Resolve claims issues that flow to the credentialing worklist within the billing platform in all markets that are related to credentialing disconnects and/or education opportunities.

Communication and Inter-Departmental Functions

• Collaborate with the Billing, Compliance, Clinical and Product teams to ensure payer contracts and enrolled providers are properly updated within applicable software platforms.
• Develop and update internal tools to track project progress and provide visibility and accountability into the credentialing process.
• Lead and participate in internal and external interdepartmental meetings to maintain and expand business process efficiency, issue management and staff education or training.
• Routinely communicate updates across the organization as appropriate.

About You

• 8+ years of relevant professional experience in credentialing and at least 2 years in a leadership or management capacity; Certified Provider Credentialing Specialist (CPCS) preferred.
• Extensive experience with and knowledge of primary source verification, CAQH, PECOS standards and credentialing processes, including NCQA and URAC. 
• Experience working with credentialing databases and software, Verifiable experience a plus.
• Experience managing delegated credentialing.
• Experience managing payer applications in multiple markets
• Experience  creating, implementing, documenting and auditing policies and procedures as it relates to credentialing.
• Proven track record of achieving high levels of accuracy and maintaining compliance in credentialing processes.
• Have a track record of successfully managing large, high impact projects preferred.
• Ability to lead, develop, mentor, and manage staff to achieve departmental and organization goals and objectives. Experience managing remote employees a plus. (While this role will not immediately have any direct reports, we are ideally looking for someone with management experience to take on reports, if and as needed, as we scale.)
• Ability to effectively prioritize and execute tasks; you have a self-starting mindset and high sense of ownership; you are excited to solve complex problems and build processes. 
• An ability to learn quickly and have a comfort with ambiguity and a faster pace of working.
• A comfort and familiarity with tech with the ability to pick up new platforms with ease. Experience with Google workspace, Excel, and Slack (or similar applications) required. 
• Exceptional written and verbal communication skills, with the ability to interact with individuals at all levels of the organization and experience working with physicians and clinical staff in a collaborative manner.

Compensation and Benefits

• The salary range for this role is $80k-95k commensurate with experience
• Full-time role in a fully remote environment
• Unlimited paid time-off inclusive of sick and vacation days
• Medical, dental, and vision benefits provided to you and your dependents at no cost
• Option to participate in 401k plan
• An opportunity to use your skills to help improve nutrition and population health at a mission-driven company

More about Season

Season is a series-A stage business backed by Andreessen-Horowitz, LRV Health, 8VC, Bain Capital, Healthy.VC and Grand Central Tech among others. 

Season recruits, employs, compensates, and promotes regardless of race, religion, sex, national origin, ethnicity, gender identity, disability, age, veteran status and other protected status as required by applicable law and as a matter of our company ethics.