Altais, Inc.
• $89K — $107K *Qualifications
Responsibilities
Benefits
About the Role
Are you looking to join a fast-growing, dynamic team?
We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.
This role is responsible for the strategic direction and operational oversight of the credentialing function to support, develop, manage and monitor processes and procedures for the credentialing, re-credentialing, expirables data management and delegated functions for all our Health Plan Partners for all lines of business.This role manages the credentialing program for Altais affiliated entities, including employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution including application management and primary source verification completion. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and accrediting body requirements including but not limited to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), and the Department of Managed Health Care (DMHC). This role, in combination with the Credentialing team, is to maintain procedures, processes and internal & vendor systems in line with all regulation and compliance requirements. This role has key vendor management oversight responsibilities to ensure our contracted vendor systems and services are delivering services and capabilities as expected. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect overall business operations and financial outcomes. At the senior level, this role owns the credentialing policy portfolio, the development and maintenance of departmental training documentation, preparation and facilitation of the Credentialing Committee, pre-delegation and ongoing oversight audits of sub-delegated entities, and the development of key performance indicators and executive reporting for the function.
You will focus on:
Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accuratein a timely manner
Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations with a continued focus on delivery of a high-quality product with the greatest level of efficiency
Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
Manages relationships with health plan delegation oversight teams.
Manages peer review physician documentation for Clinical Advisory Group
Develops, maintains, and annually reviews credentialing training documents, desktop procedures, and onboarding materials for the credentialing team
Conduct audits of the credentialing database, confirmingaccurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions
Owns Credentialing Database system modifications and workflows development and implementation
Manages vendor systems and services performance
Leads credentialing committee effectiveness in partnership with the Chief Medical Officer. Prepares and facilitates the Credentialing Committee, including agenda development, file preparation and presentation, meeting minutes, and follow-through on committee determinations
Conducts pre-delegation and annual oversight audits of sub-delegated entities, evaluates compliance against NCQA, CMS, and DMHC requirements, issues corrective action plans, and monitors remediation to closure
Owns the credentialing policy portfolio, including annual review, revision, and approval routing of policies and procedures to maintain alignment with regulatory and accreditation standards
Develops key performance indicators for the credentialing function and creates recurring dashboards and ad hoc reporting for executive leadership
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services.
Identifies and resolves technical, operational and organization problems outside own team
Other duties as assigned
The Skills, Experience & Education You Bring
Bachelor’s degree or equivalent to4 yearuniversity degree, preferably in healthcarerelated field of study.
10+ years professional experience working in credentialing, preferably in a managed care setting required.
2+ years of employee / team management experience.
Requires advanced knowledge of credentialing software and CRM tools plus expert working knowledge of NCQA, CMS Conditions of Participation, Medicare Advantage requirements, and DMHC regulations, including delegation oversight and audit readiness.
Required Certifications
Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within18 monthsof employment
NAMSS Credentialing certification preferred.
The Base Salary for this position is$89,250 – 107,100/year
In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
Excellent medical, vision, and dental coverage
401k savings plan with a company match
Flexible time off and 9 Paid Holidays
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