Credentialing Specialist
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Job Description
Delegated credentialing specialist managing payer audits, compliance, and provider records for Tava Health’s accessible mental healthcare platform. Supporting Credentialing Committee operations and NP and group-practice credentialing.
Responsibilities:
- Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits
- Monitor NCQA guidance, state regulations, and accreditation updates; assess operational impact and implement compliance changes
- Prepare for and facilitate pre-delegation and annual credentialing audits; develop and track corrective action plans through resolution
- Maintain complete, audit-ready credentialing records, including primary source verification, Credentialing Committee documentation, and adverse action logs
- Prepare recurring deliverables for delegated partners and payers, such as provider rosters, audit materials, and credentialing activity reports
- Monitor average time to credential, identify delays, manage follow-up, and escalate issues as needed
- Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and reconcile internal records against delegated payer rosters
- Serve as a point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items
- Support implementation of new delegated credentialing agreements, including processes and controls for contractual requirements
- Lead Credentialing Committee meetings, including preparation, execution, minutes, training materials, records, and follow-up
- Lead credentialing for Nurse Practitioners, including application review, primary source verification, committee readiness, payer submissions, follow-up, and status tracking
- Support credentialing for group practice providers by coordinating documentation, resolving application gaps, monitoring timelines, and maintaining accurate provider records
Requirements:
- 2–5 years of credentialing and enrollment experience, including at least 2 years specifically focused on delegated credentialing
- Certified Provider Credentialing Specialist (CPCS) certification through NAMSS
- Ability to manage multiple payer relationships and responsibilities with minimal oversight
- Self-motivated team player who thrives in multi-tasking environment and can adjust priorities
- High attention to detail, strong organization, and excellent documentation skills
- Outstanding written and verbal communication
- High-growth/tech-enabled healthcare background preferred; behavioral health experience is a plus
- Familiarity with CAQH, NPDB, PECOS, state licensing resources, credentialing software, and payer rostering tools
- Candidates must have authorization to work in the U.S. without company sponsorship now or in the future
Benefits:
- Competitive salary and stock options
- Fully-covered medical and dental premiums for you and your family, plus voluntary insurance options
- Free, generous Tava mental health benefit
- Monthly HSA contributions for qualifying enrolled employees
- Generous PTO and paid holidays
- Paid parental leave
- 401(k) retirement plan
- Weekly company-paid lunch via DoorDash and a personal DashPass subscription
- Opportunity to make a meaningful impact at a high-growth, mission-driven company
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