Lead Manager, Credentialing and Compliance Oversight
2 weeks ago
Mission Statement: Our goal is to dismantle every obstacle to mental health access.
At Spring Health, we are committed to transforming mental healthcare by eliminating barriers that hinder individuals from receiving timely assistance. Our clinically validated technology, Precision Mental Healthcare, enables us to provide personalized care—be it therapy, coaching, medication, or other services—tailored to the unique needs of each person.
We proudly collaborate with over 450 organizations, ranging from emerging startups to established Fortune 500 companies, as a premier provider of mental health services, catering to 10 million individuals. Our esteemed clients include well-known brands such as Microsoft, Target, J.P. Morgan Chase, and Delta Airlines, all of whom rely on us for exceptional outcomes for their global workforce. Through our innovative platform, we have achieved a net positive ROI for employers and are the sole entity in our sector to receive external validation of net savings for our clients.
With backing from notable investors including Generation Investment, Kinnevik, Tiger Global, William K Warren Foundation, Northzone, RRE Ventures, and others, our recent Series E Funding has propelled our valuation to $3.3 billion. We are just beginning—join us in our mission to make mental healthcare universally accessible.
Key Responsibilities:
- Supervise all facets of the credentialing and recredentialing processes for practitioners, ensuring alignment with State, Federal, and NCQA standards, along with directives from contracted health plans, including pre-delegation and annual audits of credentialing delegated entities.
- Manage and uphold quality in credentialing operations, providing oversight to facilitate the ongoing growth and development of the organization.
- Collaborate across departments including Product, Health Plan Operations, Medical Affairs, and Compliance to extract and analyze reports, ensuring credentialing data aligns with organizational objectives and regulatory standards.
- Serve as the Subject Matter Expert (SME) for credentialing processes and systems, offering guidance and support to internal stakeholders to guarantee compliance and operational 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 deployment 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, ensuring timely and accurate enrollment of providers with Medicare, Medicaid, and managed care programs.
- Maintain awareness of network adequacy and provider network standards to ensure compliance with regulatory and contractual obligations. Manage provider data through regular audits to ensure accuracy and integrity in credentialing databases and systems, collaborating with data management teams to implement data quality initiatives and resolve discrepancies efficiently.
- Work closely with the Revenue Cycle Management (RCM) team to ensure that provider credentialing and enrollment statuses are current, facilitating successful claims processing and reimbursement.
- Provide strong leadership and development opportunities for the credentialing team, fostering a collaborative and high-performance culture.
Success Metrics:
- Reduction in the time required to credential new providers.
- High compliance rates with NCQA and other regulatory standards.
- Successful implementation and adoption of new credentialing tools and systems.
- Positive feedback from internal and external stakeholders regarding credentialing processes.
- Effective and timely completion of all credentialing-related audits and reviews.
- Strong team performance and development, with measurable improvements in team engagement and effectiveness.
Qualifications:
- A minimum of 7 years of experience in a quality-focused role within healthcare, emphasizing provider credentialing, data integrity, and managing provider network adequacy in a health plan environment.
- Proven experience in developing policy and procedure documentation.
- Familiarity with NCQA Accreditation requirements and experience in 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 collaboration with cross-functional teams.
- Data-driven and analytical, with demonstrated skills in gathering, analyzing, and interpreting data using Google Sheets/MS Excel.
- Excellent oral and written communication skills, with the ability to convey compelling narratives using data.
- A thoughtful and collaborative approach to problem-solving.
- Demonstrated passion for and understanding of mental health and the broader U.S. healthcare system.
Preferred Qualifications:
- NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
- CPHQ, CPPS, CPHRM, or similar certification.
- Experience leading contractual, regulatory, and accreditation survey preparation (TJC, NCQA, Payers, etc.) and new quality accreditation initiatives.
- Experience in selecting, implementing, and managing new software systems.
The target base salary range for this position is $110,000 - $142,500, part of a competitive total rewards package including stock options and benefits. Individual pay may vary based on experience, location, internal pay equity, and other relevant business considerations.
Benefits:
- Comprehensive health, dental, and vision benefits starting on the first day of employment.
- Annual allotment of no-cost visits to the Spring Health network of therapists, coaches, and medication management providers.
- Flexible paid time off, in addition to 12 paid holidays per year.
- Access to professional development reimbursement and donation matching for charitable contributions.
Commitment to Diversity:
Spring Health is dedicated to fostering a diverse, inclusive, and authentic workplace. We encourage applicants from all backgrounds to apply, even if they do not meet every qualification listed.
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New York, New York, United States Spring Health Full timePosition OverviewMission Statement: Our goal is to dismantle every obstacle to mental health access.At Spring Health, we are committed to transforming mental healthcare by eliminating barriers that hinder individuals from receiving timely assistance. Our validated technology, Precision Mental Healthcare, enables us to provide personalized care—be it...
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New York, New York, United States Spring Health Full timePosition OverviewMission Statement: Our aim is to dismantle every obstacle to mental health access.At Spring Health, we are committed to transforming mental healthcare by eliminating barriers that hinder individuals from receiving timely assistance. Our clinically validated technology, Precision Mental Healthcare, enables us to provide personalized care—be...
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