Licensing and Credentialing Specialist

The Licensing and Credentialing Specialist is a vital part of Nema’s Clinical Operations team, responsible for the essential work of getting our providers ready to see patients. Reporting to the Senior Director of Clinical Operations, you will ensure our clinical team is licensed, credentialed, and enrolled with insurance payers in line with our clinic’s growth plans. You are the bridge that connects a new clinician to a patient in need of life-changing trauma care.

In this role, you will manage the practical steps of a provider’s journey at Nema, from navigating the different requirements of multi-state licensing to the details of insurance enrollment. You’ll support clinician onboarding, and work closely with therapists and doctors to obtain and renew state licenses and relevant certifications.

You will work closely with the Operations, Clinical, and Revenue Cycle teams to resolve hurdles and make sure there are no gaps in patient care. This role is a great fit for a detail-oriented, persistent problem-solver who understands that behind every intricate step to the process is a clinician ready to help a survivor start their path to healing.

Responsibilities:

State Licensing

• Complete initial and renewal applications for clinical state licensure for medical doctors, psychologists and therapists. Conduct follow-up and problem resolution as needed.
• Work closely with individual clinicians to ensure collection and maintenance of licensing materials.
• Track license and certification expirations for all providers to ensure timely renewals.
• Keep management informed of progress and escalate issues as needed related to licenses and other relevant certifications.
• Completes renewal process for controlled substance registrations and other relevant certifications
• Organize CE requirements for medical and behavioral health staff, including management of vendor platforms that organize and support CE completion.
  
  

Credentialing & Payer Enrollment

• Complete provider credentialing and re-credentialing licensing applications within state guidelines
• Maintain accuracy of provider data in CAQH and internal databases
• Ensure strict confidentiality of credentialing licensing files and databases
• Enroll providers into new and existing health plans
• Uphold all payer-specific policies and procedures
  
  

Daily Operations

• Provide project assistance to clinical, operations and product departments as needed
• Build and maintain reference materials and standard operating procedures 
  
  

Qualifications

Required

• 3+ years of experience in state licensing applications (submissions, verifications, renewals) for medical and behavioral health providers
• Experience with CAQH management and primary source verification
• Experience managing insurance credentialing processes
• A strength in organization and ability to prioritize multiple, sometimes conflicting, tasks
• A sharp eye for detail and a level of persistence that matches the needs of this role
• An ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization

Preferred

• Early stage healthcare start-up experience
• High School degree or higher
  
  
  

Nema Health is an early stage company looking to build and grow nationally. This is a full time, exempt, salaried position reporting to the Clinical Operations Sr. Director. Compensation will be determined by the candidate's experience and qualifications, with a base salary range of $60,000-$75.000. The full-time compensation package will include PTO, a healthcare stipend, a 401(k) with matching, an annual education stipend, an annual “work from home” stipend, and paid parental leave. This role is remote and the candidate can be located anywhere in the United States.