Payer Credentialing Lead - Delegated

Tava Health; Texas; Hybrid; USD 60.000 - 90.000; Vollzeit

Benefits dieser Stelle

Stock options

Medical and dental coverage

Mental health benefit

HSA contributions

PTO & holidays

Parental leave

401(k)

Company lunches

Impactful work

Zusammenfassung

Tava Health is seeking a Delegated Credentialing Specialist to own the day-to-day delegated credentialing program across assigned payer relationships. You will manage payer audits, compliance reporting, audit-ready files, corrective action plans, provider-data reconciliation, and credentialing operations.

The role supports credentialing for Nurse Practitioners and group practices, partners with cross-functional teams, and ensures timely, accurate credentialing activities in a fast-growth,

Qualifikationen

• 2–5 years credentialing and enrollment experience, incl. 2 years in delegated credentialing.
• CPCS certification required.
• Ability to manage multiple payer relationships with minimal oversight.
• Self-motivated team player who thrives in a multi-tasking environment.
• High attention to detail and excellent documentation.

Aufgaben

• Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, compliance monitoring, reporting and audits.
• Monitor NCQA guidance, state regulations, and accreditation updates and implement changes.
• Prepare for delegations and audits; track corrective action plans through resolution.
• Maintain audit-ready credentialing records and adverse action logs.
• Prepare recurring deliverables for delegated partners and payers.
• Monitor time-to-credential and support targets, escalating as needed.
• Collaborate with internal teams to reconcile provider data with payer rosters.
• Serve as point of contact for payer communications related to credentialing and audits.
• Support new delegated credentialing agreements and controls.

Kenntnisse

Credentialing experience

Delegated credentialing

Payer relationship management

Attention to detail

Documentation skills

Strong written and verbalcommunication

Ausbildung

CPCS certification

Tools

CAQH

NPDB

PECOS

Credentialing software

Payer rostering tools

Jobbeschreibung

Tava Health is seeking a Delegated Credentialing Specialist to own the day-to-day delegated credentialing program across assigned payer relationships. You will manage payer audits, compliance reporting, audit-ready files, corrective action plans, provider-data reconciliation, and credentialing operations.

The role supports credentialing for Nurse Practitioners and group practices, partners with cross-functional teams, and ensures timely, accurate credentialing activities in a fast-growth,