Offer summary

Qualifications:

Bachelor's degree in Healthcare Administration, Business, or related field., At least 3 years of experience in provider enrollment, credentialing, or payer relations, preferably in mental health., Knowledge of credentialing standards such as NCQA, URAC, and Joint Commission, as well as state licensing requirements., Proficiency with credentialing software like Medallion and strong organizational skills..

Key responsibilities:

Oversee sub-delegate credentialing and monitor performance metrics.

Manage end-to-end provider onboarding, enrollment, and cross-state licensing processes.

Resolve payer issues, escalations, and optimize workflows for provider enrollment.

Maintain accurate provider data and stay updated on credentialing regulations.

Job description

Sr Licensing & Credentialing Specialist

Overview:
The Provider Enrollment & Credentialing Coordinator is responsible for overseeing the sub-delegate credentialing partner (Medallion) while managing the end-to-end onboarding and enrollment process for mental health providers. This role ensures compliance with payer requirements, manages cross-state licensing processes, and handles provider demographic updates. Additionally, the coordinator will resolve payer issues, track escalations, and optimize workflows for provider onboarding and enrollment.

Key Responsibilities:
Sub-Delegate & Credentialing Oversight:

Monitor credentialing timelines, accuracy, and performance metrics of the sub-delegate.
Conduct periodic audits and ensure proper documentation for payer reviews.

Provider Onboarding & Enrollment:

Oversee the end-to-end provider onboarding process, ensuring smooth transitions from hiring to credentialing and enrollment.
Develop and maintain standard operating procedures (SOPs) for onboarding workflows.
Work cross-functionally with HR, clinical leadership, and operations to ensure provider setup is efficient and accurate.

Cross-State Licensing & Payer Enrollment:

Manage the cross-licensing process for providers practicing across multiple states, ensuring compliance with state regulations.
Oversee payer enrollment workflows, ensuring timely submission and approval with commercial, Medicare Advantage, and Medicaid payers.
Identify and resolve payer enrollment issues and escalations, including delays, denials, or data discrepancies.

Provider Data & Demographics Management:

Maintain accurate provider demographic information, licensure, and payer enrollments in credentialing and enrollment systems.
Process updates related to provider relocations, name changes, NPI updates, and practice site changes.
Ensure payers and credentialing bodies receive updated provider data in a timely manner.

Issue Resolution & Workflow Optimization:

Troubleshoot and resolve payer escalations, application rejections, and provider enrollment delays.
Identify process inefficiencies and implement automation and workflow improvements.
Stay updated on payer policy changes, state licensing requirements, and credentialing regulations.

Qualifications & Skills:

Education: Bachelor’s degree in Healthcare Administration, Business, or related field (preferred).
Experience: 3+ years in provider enrollment, credentialing, or payer relations, preferably within mental health.
Experience managing delegated credentialing relationships and provider onboarding workflows.
Knowledge of NCQA, URAC, Joint Commission, and state-specific licensing requirements.
Strong understanding of payer enrollment processes for commercial, Medicare Advantage, and Medicaid.
Proficiency in Medallion or similar credentialing software.
Excellent problem-solving and organizational skills for managing escalations and workflow improvements.

Successful Thriveworks employees believe in our mission, they embody our core values, which focus on Community, Purpose, Integrity, Access, Quality, and the ability to achieve our goals and work well together. If you fit the bill and belong on our team, apply today!

Physical demands for Thriveworks positions may include being sedentary for long periods of time. Entering text or data into a computer by means of a traditional keyboard is also a requirement.

Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team.

Interested in joining Team Thriveworks? We're thrilled to meet you!

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Our recruiters and other team members will only email you from thriveworks@myworkday.com or an @thriveworks.com email address.
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