Credentialing Manager

OpenKrill; United States; On-site; USD 80,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental and Vision plans

401k with matching

Remote-first Environment

Wellness stipend

Job summary

Talkspace is seeking an experienced Credentialing Manager to lead a Credentialing team within Clinical Quality Operations. This remote role partners with CVOs to streamline workflows, prepare committee reports, and ensure compliance with NCQA standards.

The position focuses on leadership, process optimization, and data-driven credentialing decisions for a provider network while maintaining a remote-first work environment.

Qualifications

• Bachelor's degree or 7+ years in credentialing or healthcare operations.
• Experience with CVOs and delegated credentialing agreements.
• Familiar with NCQA standards and policy reviews.

Responsibilities

• Lead and mentor Credentialing Interns, Associates, Specialists, and Supervisors.
• Prepare credentialing packets and report KPI metrics for committees.
• Collaborate with CVO and Credentialing Supervisors to ensure timely file processing.
• Drive process improvements and audits of credentialing workflows.

Skills

Team Leadership

Credentialing Operations

CVO liaison

NCQA standards

Excel

Google Suite

Reporting & analytics

Education

Bachelor's Degree

Tools

Credentialing software

Excel

Google Workspace

Job description

At Talkspace, we are committed to fostering a diverse, equitable, inclusive, and belonging-centered workplace where everyone can thrive while making a difference in mental health. Want to help over two million people receive quality mental healthcare? Come join our mission of getting therapy in the hands of everyone!

We are looking for an experienced Credentialing Manager to join our Credentialing (Clinical Quality Operations) team. This role would be responsible for streamlining operational processes and optimizing credentialing workflows. Key responsibilities include assisting in the leadership of Credentialing Interns, Associates, Specialists, and Supervisors to ensure alignment with organizational goals and operational efficiency. We are looking for someone who has experience preparing reports for Credentialing Committees and collaborating with Credentialing Verification Organizations (CVO) to resolve discrepancies, and who wants to bring their talents into a "for purpose" space. To work at Talkspace, you need to be as passionate as we are about our work, and excited to partner with us on delivering quality mental healthcare.

This is a remote position working Monday - Friday 9a-6p local time. Talkspace Headquarters is located in NYC but you are not required to live in New York.

What You'll Do

Supervisor responsibilities

• Lead and manage a small group of Credentialing Interns, Associates, and Specialists, overseeing job assignments, performance reviews, and professional development while ensuring alignment with organizational goals.
• Approve timesheets, provide mentorship, and offer strategic support to optimize team performance and ensure operational success.

Credentialing

• Ensure streamlining of operational processes related to credentialing
• Partner with the Senior Credentialing Manager to prepare and present comprehensive credentialing packets for the Credentialing Committee as needed, including flagged file reviews, coordination of logistics, and reporting on credentialing KPIs.
• Liaise with the Credentialing Verification Organization (CVO) to and the Credentialing Supervisor to ensure the timely completion, downloading, and uploading of files, and maintain accurate system updates reflecting credentialing decisions.
• Support of the Senior Credentialing Manager to proactively collaborate with the CVO, Credentialing Supervisor credentialing Specialists to address outreach improvements, resolve inconsistencies, and facilitate weekly meetings to enhance the credentialing process.

Re-credentialing

• Ensure a timely initiation of the re-credentialing process for the provider network with review of quality and complaint data as well as documentation and movement of providers into the process of re-credentialing to initiate the re-credentialing review
• Identifying non-engaging, zero-caseload providers and processing them for administrative termination when unresponsive.
• Seamless and efficient re-credentialing process for the provider network, maintaining compliance with regulatory and organizational standards.
• Coordinate with the CVO to guarantee the timely review and completion of re-credentialing processes for all clinicians while ensuring the next re-credentialing cycle is accurately scheduled.

Delegation Management

• Support the Senior Credentialing Manager in maintaining and strengthening relationships with Enterprise clients and Account Management under delegated credentialing agreements, ensuring satisfaction and compliance with credentialing standards.
• Provide regular network update reports to Enterprise clients in accordance with delegated agreements.
• Partner with the Senior Credentialing Manager to liaise with the Business Development/Account Management team to secure new delegated contracting opportunities by completing and submitting pre-delegation enrollment packets, documenting and tracking progress and outcomes as required.
• Provide monthly roster reports to Enterprise clients as required with tracking and assisting with system loading for network participation for specialized plans

Auditing and Compliance

• Conduct regular audits of the CVO’s credentialing processes to ensure operational efficiency, accuracy, and compliance with internal and external standards.
• Conduct quarterly internal audits to validate the accuracy and efficiency of the Credentialing Program.
• Collaborate with Enterprise clients to provide data for annual, monthly, or ad hoc audits, ensuring transparency and compliance.

Licensing and Ongoing Monitoring Compliance Management

• Oversee the review of credentialed licenses to ensure all provider information is up-to-date and accurate, maintaining compliance with regulatory and organizational requirements.
• Support the Senior Credentialing Manager with documentation and reporting for ongoing monitoring requirements

Process Improvement and Workflow Optimization

• Align with the Senior Credentialing Manager in the continuous review and refinement of credentialing workflows, ensuring the implementation of best practices and maximizing operational efficiencies within the credentialing program.
• Performs other related duties as assigned.

About You

• Bachelor’s Degree required (Master’s Degree preferred) or 7+ years of professional experience in credentialing or a related field.
• 4+ years of professional experience in a credentialing, compliance, or healthcare operations role, with proven experience in team leadership and process management.
• Strong background in managing credentialing operations, including experience working with Credentialing Verification Organizations (CVOs) and handling delegated credentialing agreements.
• Familiar with NCQA standards and guidelines as well as policy and contract review to ensure compliance with said standards.
• Demonstrated ability to manage cross-functional teams, lead projects, and streamline workflows to optimize efficiency.
• Excellent communication, organizational, and problem-solving skills, with a strong focus on collaboration with both internal and external stakeholders.
• Experience in conducting audits, maintaining compliance with regulatory standards, and implementing process improvements.
• Familiarity with credentialing software and systems, as well as proficiency in reporting on credentialing metrics.
• Proficient with Mac devices, Excel, Word, Google Suite (sheets, docs)

Benefits

• Comprehensive Medical, Dental and Vision plans
• Pre-tax benefits: HSA/ FSA
• 401k Retirement Savings Program with matching
• Voluntary benefits including disability, basic life or pet insurance, etc.
• Monthly Wellness Stipend to promote mental and physical self-care
• Flexible PTO and Remote First Environment
• Regular team events, including Wellness Workshops and Team Building Events
• Free access to Talkspace products for you and one household member, as well as access to a friends and family discount!

Compensation

At Talkspace, we believe that pay transparency during the interview process is a critical part of diversity, equity, and inclusion. Our salary bands are based on internal and external compensation benchmarks, which we regularly evaluate to ensure we pay competitively.

The base salary range for this role is between $80,000 and $90,000/yr. Within the salary bands, leveling corresponds to each candidate’s relevant experience, skills as assessed during the interview process, education, and applicable certifications.

Why Talkspace?

Talkspace is the world's leading online therapy company, serving over 2 million users looking to begin their wellness journey through tele-health. According to the World Health Organization, close to 1 billion people worldwide live with a mental disorder, and on average more than 75% with mental, neurological, and substance use disorders receive no treatment for their condition at all. Additionally, one-third of the world's population - 2 billion people - live in countries that