Delegated Credentialing Specialist – Payer Compliance

Saasventurecapital; United States; A distancia; USD 85.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Stock options

Medical and dental premiums covered

Mental health benefit

HSAs contributions

Paid time off

Parental leave

401(k) retirement plan

Company lunch

Impactful work

Descripción de la vacante

Tava Health is seeking a Delegated Credentialing Specialist to own day-to-day delegated credentialing across payer relationships. You will manage audits, compliance, and provider data reconciliation, supporting Nurse Practitioners and group practices throughout the credentialing lifecycle.

You will coordinate with Enrollment, Partnerships, Revenue Cycle, and Legal/Compliance teams to ensure audit-ready records and timely credentialing actions, contributing to high-quality care access.

Formación

• 2–5 years of credentialing and enrollment experience, including at least 2 years focused on delegated credentialing.
• CPCS certification.
• Ability to manage multiple payer relationships with minimal oversight.
• Self-motivated team player with strong multitasking.
• High attention to detail, organization, and documentation skills.
• Outstanding written and verbal communication.

Responsabilidades

• Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits.
• Monitor NCQA guidance, state regulations, and other accreditation updates; implement compliance changes.
• Prepare for and facilitate credentialing audits in accordance with NCQA and payer requirements; track corrective actions.
• Maintain audit-ready credentialing records including primary source verification and adverse action logs.
• Prepare recurring deliverables for delegated partners and payers, such as provider rosters and activity reports.
• Monitor average time to credential and support targets by identifying delays and escalating issues.

Conocimientos

Credentialing

CPCS certification

Multi-tasking

Attention to detail

Documentation skills

Communication skills

CAQH familiarity

NPDB knowledge

PECOS knowledge

Payer management

Healthcare background

Payer rostering tools

Herramientas

CAQH

NPDB

PECOS

Payer rostering tools

Descripción del empleo

Tava Health is seeking a Delegated Credentialing Specialist to own day-to-day delegated credentialing across payer relationships. You will manage audits, compliance, and provider data reconciliation, supporting Nurse Practitioners and group practices throughout the credentialing lifecycle.

You will coordinate with Enrollment, Partnerships, Revenue Cycle, and Legal/Compliance teams to ensure audit-ready records and timely credentialing actions, contributing to high-quality care access.