DescriptionWORK AS RIA HEALTH'S CREDENTIALING AND LICENSING MANAGER
The manager works under the Clinical Operations Department to onboard new Ria Health clinicians and run licensure and credentialing workflows.
This role is responsible for the completion of credentialing, licensing, and compliance goals, management of contracted Credentialing Verification Organizations (CVO)s, and implementation of new payer relationships and provider onboarding. As part of a fast-paced, high growth company, the person in this role must be able to manage and execute credentialing functions and provide a high level of support to Ria's clinicians.
RESPONSIBILITIES:
- LEADERSHIP
- Represents the credentialing department through regular reporting and updates at staff meetings
- Manages and improves credentialing and licensing workflows at Ria Health to scale
- Stays up to date on changes/additions to regulations related to requirements to credentialing, state licensing and prescribing rules (DEAs, NP supervision, etc) and makes corresponding updates to Ria policies and procedures within this scope
- Prepares minutes, rosters and files for internal Credentialing Committee Meetings and Medical Staff Meetings
- Implements new payer accounts for credentialing and establishes relationship with credentialing teams at the payer/plan.
- Manages multiple vendors (CVOs) and ensures adherence to SLAs
- Effectively communicates in writing and verbally routinely with providers and provides high-touch support in the completion of licensing and credentialing tasks
- ONBOARDING & CREDENTIALING
- Onboards and initiates credentialing of new providers. This includes:
- Internal system set up,
- Updating CAQH profiles
- Requesting and managing payor enrollments (via external vendor)
- Executing internal supervision agreements between MD and NPs & Psychotherapist and coaches
- Maintains current malpractice roster
- Offboards providers in compliance with credentialing policies and procedures
- Completes Medicare and Medicaid group and provider enrollments
- Ongoing Provider Enrollment Efforts and Credentialing Network Management
- Provides regular roster updates to payor partners and internally
- LICENSING
- Maintenance and completion of provider license renewals
- Manages new license applications (via external vendor)
- Develops Continuing Medical Education resources designed to minimize the requirements for providers with multi-state licenses
- SUPERVISION AND PRESCRIBING
- Ensures Nurse Practitioner supervision requirements are met including implementing agreements, supervisor/ supervisee meeting verifications, and appropriate and required documentation is completed and stored in a manner that allows easy retrieval when necessary.
REQUIREMENTS: EDUCATION AND EXPERIENCE
- Bachelor's Degree
- Min. 5-7 years of credentialing experience
- Proficiency with CAQH profiles, Medicare and Medicaid enrollment
- Experience with credentialing and licensing processes
- High attention to detail and documentation
- Excellent written and verbal communication skills
- Ability to make decisions and drive projects forward amidst ambiguity
- Process-driven
- Background working in high-growth, start-up companies a plus
ENJOY RIA HEALTH BENEFITS
- Become part of a mission-driven team delivering innovative, next-generation care for alcohol use disorder
- Grow professionally within a rapidly scaling tech-enabled healthcare organization
- Competitive compensation packages
- Comprehensive medical, dental, and vision insurance
- Paid time off (PTO) that supports work-life balance
- Remote and hybrid work options based on role and business needs
- Ongoing telehealth training, development, and learning opportunities
