Credentialing Manager

<div class="content-intro">Alma is on a mission to simplify access to high-quality, affordable mental health care. We do this by making it easy and financially rewarding for therapists to accept insurance and offer in-network care. When a provider joins Alma, they gain access to a suite of tools that not only help them better run their business, but also grow it sustainably and develop as a provider. Alma is available in all 50 states, with over 20,000 therapists in our growing network. Anyone looking for a therapist can browse Alma’s free directory. Alma has raised $220.5M in funding from Insight Partners, Optum Ventures, Tusk Venture Partners, Primary Venture Partners, First Round Capital, Sound Ventures, BoxGroup, Cigna Ventures, and Rainfall Ventures. Alma was also named one of Inc’s Best Workplaces in 2022 and 2023.<div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content"><a href="https://helloalma.com/" target="_blank">Website</a></div><div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content"><a href="https://boards.greenhouse.io/alma" target="_blank">Job Board</a></div><div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content"><a href="https://docs.google.com/document/d/1cg1oEuMmxHsRw_45o0pANQycrwKJjub3_EdQDtEnrAc/edit" target="_blank">Values</a></div><div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content"><a href="https://drive.google.com/file/d/1-BIGrWstawQLTr8aFmmbjMXBA4YaYsVK/view?usp=sharing" target="_blank">Candidate Interview Guide </a></div><div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content"> </div><div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content">---</div><div class="c-message__content c-message__content--feature_sonic_inputs" data-qa="message_content"> </div></div>Credentialing ManagerWe’re looking for a leader with significant experience in healthcare credentialing, compliance, and process improvement. The Credentialing Manager is a critical role responsible for ensuring the organization's audit readiness and adherence to all regulatory and contractual requirements related to delegated credentialing. This individual will develop and own the quantifiable Compliance Scorecard, manage payer audit cycles, and lead high-impact initiatives to improve overall RCM efficiency and compliance for our platform.Key ResponsibilitiesAudit & NCQA Compliance Ownership<ul><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Delegation Audit Management: Serve as the subject matter expert and primary liaison for all insurance payer audits related to delegated credentialing agreements</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">NCQA Standard Implementation: Implement and maintain NCQA standards and requirements across all credentialing policies and procedures to uphold accreditation readiness and quality assurance</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Compliance Scorecard & KPIs: Design, implement, and maintain the Compliance Scorecard and KPIs for credentialing and RCM, demonstrating measurable improvement year-over-year</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Audit Preparedness: Ensure the organization is prepared for annual audits by developing a playbook and ensuring improvements based on any previous Corrective Action Plans (CAPs)</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Policy & Regulatory Monitoring: Work with Legal and Compliance to monitor changes in payer, state, and federal laws and rapidly update internal policies and Standard Operating Procedures (SOPs) accordingly</li></ul><h4>RCM Integrity and Process Improvement</h4><ul><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">RCM Compliance Leadership: Lead compliance efforts within the RCM division, focusing on the regulatory intersections between credentialing, enrollment, and claims processing</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Efficiency & Scalability: Identify and eliminate bottlenecks in the Credentialing and RCM workflows, specifically targeting root causes of claim denials and credentialing delays to improve the Clean Claim Rate</li></ul><h4>Leadership & Cross-Functional Management</h4><ul><li style="font-family: helvetica, arial, sans-serif;">Partner Oversight: Oversee the performance of any Credentials Verification Organization (CVO) partners and internal support partners to ensure their work meets NCQA and organizational quality standards</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Compliance Training: Ensure annual required trainings are completed for all RCM and Credentialing staff</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Committee Support: Facilitate and support the Credentialing Committee, ensuring committee decisions are documented and adhered to in alignment with all policies and procedures</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Execution-Oriented Mindset: Act as a hands-on individual contributor when necessary, diving into operational details, troubleshooting issues, and executing complex tasks to drive continuous improvement</li></ul>What you bring <ul><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Robust Credentialing Leadership: 6+ years of progressive experience in healthcare credentialing, with a significant portion dedicated to managing delegated functions</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Delegated Credentialing Expertise: Deep, demonstrated experience supporting and managing delegated credentialing agreements, including familiarity with pre- and post-delegation audit requirements and payer submission processes</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">NCQA Proficiency: Deep understanding and practical experience with NCQA standards and their application to both credentialing files and quality committee structure</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">RCM Compliance & Behavioral Health Knowledge: Strong working knowledge of the Revenue Cycle Management process and the regulatory nuances specific to mental/behavioral health services (e.g., medical necessity documentation)</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Compliance Measurement: Proven experience establishing, monitoring, and reporting compliance KPIs and scorecards</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Project Management & Organization: Exceptional organizational and project management skills with a demonstrated ability to manage complex, detailed, and timeline-driven compliance projects independently</li></ul><h4>Required Qualifications</h4><ul><li style="font-size: 12pt; font-family: helvetica, arial, sans-serif;">Proven ability to interpret complex regulatory language (NCQA, CMS, etc.) and translate it into operational workflows</li><li style="font-size: 12pt; font-family: helvetica, arial, sans-serif;">6+ years of progressive experience in healthcare credentialing, with a focus on managing delegated functions</li></ul><h4>Preferred Qualifications</h4><ul><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Professional Certification: CPCS (Certified Provider Credentialing Specialist) or CHPC (Certified in Healthcare Privacy and Compliance)</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Experience in the Mental Health/Behavioral Health sector, understanding specific parity requirements and documentation rules</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Experience working in a high-growth healthcare technology or start-up environment</li></ul>Benefits:<ul><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">We’re a remote-first company</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Health insurance plans through Aetna (medical and dental) and MetLife (vision), including FSA and HSA plans</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">401K plan (ADP)</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Monthly therapy and wellness stipends</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Monthly co-working space membership stipend</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Monthly work-from-home stipend</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Financial wellness benefits through Northstar</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Pet discount program through United Pet Care</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Financial perks and rewards through BenefitHub</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">EAP access through Aetna</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">One-time home office stipend to set up your home office</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Comprehensive parental leave plans</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">12 paid holidays and 1 Alma Give Back Day</li><li style="font-family: helvetica, arial, sans-serif; font-size: 12pt;">Flexible PTO </li></ul>Salary Band: $110,000 - $130,000 All Alma jobs are listed on our careers page. We do not use outside applications or automated text messaging in our recruiting process. We will not ask for any sensitive financial or identification information throughout the recruiting process. Any communication during the recruitment process, including interview requests or job offers, will come directly from a recruiting team member with a helloalma.com email address.<div class="content-conclusion">Learn more about how Alma handles applicant data by reading Alma's <a class="c-link" href="https://helloalma.com/applicant-privacy-policy/" target="_blank" data-stringify-link="https://helloalma.com/applicant-privacy-policy/" data-sk="tooltip_parent">Applicant Privacy Notice</a>.</div>

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