Remote Associate Director, Credentialing and Network Compliance

Summary

Join Spring Health on our mission to eliminate every barrier to mental health. We're revolutionizing mental healthcare by removing barriers and delivering the right care at the right time, tailored to each individual's needs.

Requirements

• Minimum of 7 years of experience in a quality-focused role in healthcare, with a strong emphasis on provider credentialing, provider data integrity, and managing provider network adequacy within a health plan setting
• Demonstrated experience in developing policy and procedure documentation
• Knowledge of NCQA Accreditation requirements and demonstrated experience preparing for and leading accreditation and regulatory site surveys (NCQA, TJC, CMS, etc.)
• Knowledge of medical credentialing and privileging procedures and standards
• Experience in project management and partnering with cross-functional teams
• Data-driven and analytical by nature with demonstrated skills in gathering, analyzing, and interpreting data in Google Sheets/MS Excel
• Excellent oral and written communication skills—ability to fluently tell a compelling clinical, compliance, or business story with data
• A thoughtful and collaborative approach to problem-solving
• Humility, resourcefulness, empathy, and professionalism
• Demonstrated passion for, and understanding of, mental health and the broader U.S. healthcare system

Responsibilities

• Oversee all aspects of the credentialing/recredentialing of practitioners in alignment with State, Federal, and NCQA standards, as well as contracted health plan directives
• Manage and ensure quality related to credentialing operations, providing oversight to support the continued growth and development of the organization
• Work cross-functionally with Product, Health Plan Operations, Medical Affairs, and Compliance teams to pull and analyze reports, ensuring that credentialing data aligns with organizational goals and regulatory standards
• Act as the Subject Matter Expert (SME) for credentialing processes and systems, providing guidance and support to internal stakeholders to ensure compliance and efficiency
• Establish, implement, and monitor performance goals, metrics, and processes for the Credentialing department. Prepare and maintain various reports, data, and summaries of credentialing activities
• Lead the implementation of new credentialing tools and systems to enhance operational efficiency and compliance
• Oversee provider enrollment processes, including the submission, tracking and follow-up of applications, to ensure timely and accurate enrollment of providers with Medicare, Medicaid, and managed care programs
• Maintain familiarity with network adequacy and provider network standards to ensure compliance with regulatory and contractual requirements. Manage provider data by conducting regular audits to ensure the accuracy and integrity of provider information in credentialing databases and systems
• Collaborate closely with the Revenue Cycle Management (RCM) team to ensure that provider credentialing and enrollment statuses are up-to-date, facilitating successful claims processing and reimbursement
• Provide strong leadership and development opportunities to the credentialing team, fostering a collaborative and high-performance culture

Benefits

• Health, Dental, Vision benefits start on your first day at Spring Health
• Individual One Medical account which is valued at $199/year per user. HSA and FSA plans available
• Yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents
• 10 allocated sick days per year
• Flexible paid time off in addition to 12 paid holidays throughout the year
• Access to Gympass, an on-demand virtual benefit that provides wellbeing coaching, and budget management
• Spring Renewal: When you hit your four-year Springaversary, you’ll be awarded a four week fully paid sabbatical leave to renew and recharge
• 4-4.5 months of fully paid parental leave
• Spring Health provides team members and their families with sponsored access to Bright Horizons child care, back-up care, and elder care
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses