Accreditation and Credentialing Manager

Summary

Join Valera Health, a leader in tele-mental health, as their Accreditation and Credentialing Manager. You will oversee all credentialing, re-credentialing, and NCQA accreditation processes, ensuring compliance with industry and regulatory standards. Manage provider data, track licenses and certifications, and liaise with health plans and regulatory agencies. Lead the credentialing team, ensuring compliance and contributing to high-quality care delivery. The role involves managing NCQA accreditation, data, credentialing applications, documentation, CAQH database, reporting, rosters, and audits. This position offers a competitive salary and benefits package.

Requirements

• Bachelor's Degree
• 5+ years of credentialing experience
• 3+ years delegated credentialing experience
• Experience with the NCQA credentialing process
• Knowledge of provider credentialing and its direct impact on the revenue cycle
• Detail oriented with above average organizational skills

Responsibilities

• Oversee and ensure compliance with NCQA Accreditation standards for Credentialing, maintaining optimal standing
• Supervise the compilation and maintenance of accurate and current provider data, ensuring all information is up-to-date
• Manage the completion and monitoring of provider credentialing and re-credentialing applications, ensuring timely follow-up as needed
• Ensure the maintenance of up-to-date copies of state licenses, DEA certificates, malpractice coverage, and other required credentialing documents
• Monitor and update the CAQH database to ensure accuracy and compliance with CMS schedules
• Provide regular updates to leadership on delegated enrollment timelines, statuses, and other relevant metrics during meetings
• Maintain and oversee all outgoing delegated rosters
• Conduct ongoing audits of Valera PM and external tools (EHR) to ensure accurate data and insurance uploads

Preferred Qualifications

• Certified Provider Credentialing Specialist CPCS
• Tele-mental health experience
• Behavioral Health setting experience
• Startup or health plan experience
• Drive to succeed, collaborating outlook, aligns with our mission

Benefits

• Health, Vision & Dental Insurance
• 401k through the Standard
• Paid Time Off
• Short Term Disability
• Life Insurance
• Office Equipment