Associate Director, Credentialing and Network Compliance

4 weeks ago

New York, New York, United States Spring Health Full time
Job Overview

At Spring Health, we're revolutionizing mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. As the Associate Director of Credentialing and Compliance, you'll play a critical role in ensuring the accuracy and integrity of provider information in our credentialing databases and systems.

Key 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.
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.
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 net new quality accreditation efforts.
  • Experience selecting, implementing, and managing new software systems.
What We Offer

At Spring Health, we're committed to providing a competitive total rewards package, including a target base salary range of $126,740- $158,425, stock options, and benefits. We also offer a flexible work arrangement, with 66% of our team members working fully remote and 33% working in a hybrid model from our New York City offices.

We're proud to be an equal opportunity employer and are dedicated to building a diverse, inclusive, and authentic workplace. If you're excited about this role but your past experience doesn't align perfectly with every qualification, we strongly encourage you to apply.

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