Lead Manager, Credentialing and Compliance Operations

2 weeks ago

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

Mission 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 it therapy, coaching, medication, or other services—tailored to the unique needs of each person.

We proudly collaborate with over 450 organizations, ranging from startups to Fortune 500 companies, as a premier provider of mental health services, supporting 10 million individuals. Our clientele includes 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 employees worldwide. 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 clients.

Having secured funding from esteemed investors like Generation Investment, Kinnevik, Tiger Global, and others, our recent Series E funding has elevated our valuation to $3.3 billion. We are just beginning—join us in our quest to make mental healthcare universally accessible.

Key Responsibilities:

  • Oversee the entire credentialing and recredentialing process for practitioners, ensuring compliance with State, Federal, and NCQA standards, along with health plan directives, including pre-delegation and annual audits of credentialing delegated entities.
  • Manage credentialing operations to ensure quality and support the organization's growth and development.
  • Collaborate across departments such as Product, Health Plan Operations, Medical Affairs, and Compliance to analyze reports, ensuring credentialing data aligns with organizational objectives and regulatory requirements.
  • Serve as the Subject Matter Expert (SME) for credentialing processes and systems, providing guidance to internal stakeholders to maintain compliance and operational efficiency.
  • Establish and monitor performance goals, metrics, and processes for the Credentialing department, while preparing and maintaining various reports and summaries of credentialing activities.
  • Lead the introduction of new credentialing tools and systems to improve operational efficiency and compliance.
  • Oversee provider enrollment processes, ensuring timely and accurate enrollment of providers with Medicare, Medicaid, and managed care programs.
  • Maintain knowledge of network adequacy and provider network standards to ensure compliance with regulatory and contractual obligations. Conduct regular audits to ensure the accuracy of provider information in credentialing databases, collaborating with data management teams to enhance data quality initiatives.
  • Work closely with the Revenue Cycle Management (RCM) team to keep provider credentialing and enrollment statuses current, facilitating efficient claims processing and reimbursement.
  • Provide strong leadership and development opportunities for the credentialing team, fostering a collaborative and high-performance culture.

Success Metrics:

  • Reduced time 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 stakeholders regarding credentialing processes.
  • Timely completion of all credentialing-related audits and reviews.
  • Enhanced team performance and engagement.

Qualifications:

  • At least 7 years of experience in a quality-focused role within healthcare, emphasizing provider credentialing and data integrity.
  • Experience in developing policy and procedure documentation.
  • Knowledge of NCQA Accreditation requirements and experience in leading accreditation and regulatory site surveys.
  • Familiarity with medical credentialing and privileging standards.
  • Project management experience and ability to work with cross-functional teams.
  • Strong analytical skills with proficiency in data analysis tools.
  • Excellent communication skills, capable of conveying complex information clearly.
  • A collaborative approach to problem-solving.
  • Demonstrated passion for mental health and understanding of the U.S. healthcare system.

Preferred Qualifications:

  • NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
  • Relevant certifications such as CPHQ, CPPS, or CPHRM.
  • Experience in leading accreditation survey preparations and quality accreditation efforts.
  • Experience in selecting and managing new software systems.

The target base salary range for this position is $110,000 - $142,500, which is part of a competitive total rewards package that includes stock options and benefits. Individual pay may vary based on experience, location, and other relevant factors.

Benefits:

  • Comprehensive health, dental, and vision benefits starting on the first day of employment.
  • Access to a network of therapists and coaches at no cost.
  • Flexible paid time off and 12 paid holidays annually.
  • Professional development reimbursement and donation matching programs.

Commitment to Diversity:

Spring Health is dedicated to fostering a diverse and inclusive workplace. We encourage applicants from all backgrounds to apply, even if they do not meet every qualification listed.

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