Senior Manager, Credentialing and Network Compliance

at  Spring Health

OUR MISSION: TO ELIMINATE EVERY BARRIER TO MENTAL HEALTH.

Spring Health is a comprehensive mental health solution for employers and health plans. Unlike any other solution, we use clinically validated technology called Precision Mental Healthcare to pinpoint and deliver exactly what will work for each person — whether that’s meditation, coaching, therapy, medication, and beyond.
Today, Spring Health equips over 800 companies, from start-ups to multinational Fortune 500 corporations, as a leading and preferred mental health service. Companies like J.P. Morgan Chase & Co., Microsoft, J.B. Hunt, Bumble, and Instacart use the Spring Health platform to provide mental health services to thousands of their team members globally. We have raised over $370 million from prominent investors including Kinnevik, Tiger Global, Northzone, RRE Ventures, and many more. Thanks to their partnership, our current valuation has reached $2.5 billion.
Reporting to the Sr. Director, Network Growth Operations, and partnering with Onboarding, Recruiting, Compliance, Legal, Health Plan Operations and Medical Affairs, the Senior Manager of Credentialing and Compliance will own the credentialing function. This includes managing the credentialing team, implementing new credentialing tools, and leading accreditation compliance. The ideal candidate will have a strong background in healthcare credentialing, compliance, and team leadership.

PREFERRED QUALIFICATIONS:

• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
• CPHQ, CPPS, CPHRM, or similar certification.
• Experience leading contractual, regulatory and accreditation survey preparation (TJC, NCQA, Payers, etc.) and net new quality accreditation efforts.
• Experience selecting, implementing, and managing new software systems.
  The target base salary range for this position is $110,000 - $142,500, and is part of a competitive total rewards package including stock options and benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually at minimum to ensure competitive and fair pay.
  Don’t meet every requirement? Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At Spring Health we are dedicated to building a diverse, inclusive and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we strongly encourage you to apply. You may be just the right candidate for this or other roles!
  Ready to do the most impactful work of your life? Learn more about our values, how we work, and how hypergrowth meets impact at Spring Health: Our Values

WHAT YOU’LL BE DOING:

• Oversee all aspects of the credentialing/recredentialing of practitioners in alignment with State, Federal, and NCQA standards, as well as contracted health plan directives, including pre-delegation and annual audits of all credentialing delegated entities.
• Manage and ensure quality related to credentialing operations, providing oversight to support the continued growth and development of the organization.
• Work cross-functionally with Product, Health Plan Operations, Medical Affairs, and Compliance teams to pull and analyze reports, ensuring that credentialing data aligns with organizational goals and regulatory standards.
• Act as the Subject Matter Expert (SME) for credentialing processes and systems, providing guidance and support to internal stakeholders to ensure compliance and efficiency.
• Establish, implement, and monitor performance goals, metrics, and processes for the Credentialing department. Prepare and maintain various reports, data, and summaries of credentialing activities.
• Lead the implementation of new credentialing tools and systems to enhance operational efficiency and compliance.
• Oversee provider enrollment processes, including the submission, tracking and follow-up of applications, to ensure timely and accurate enrollment of providers with Medicare, Medicaid, and managed care programs.
• Maintain familiarity with network adequacy and provider network standards to ensure compliance with regulatory and contractual requirements. Manage provider data by conducting regular audits to ensure the accuracy and integrity of provider information in credentialing databases and systems, collaborating data management teams to develop and implement data quality initiatives, automate data entry processes, and resolve data discrepancies efficiently.
• Collaborate closely with the Revenue Cycle Management (RCM) team to ensure that provider credentialing and enrollment statuses are up-to-date, facilitating successful claims processing and reimbursement.
• Provide strong leadership and development opportunities to the credentialing team, fostering a collaborative and high-performance culture.

WHAT SUCCESS LOOKS LIKE IN THIS ROLE:

• Reduction in time to credential new providers.
• High compliance rates with NCQA and other regulatory standards.
• Successful implementation and adoption of new credentialing tools and systems.
• Positive feedback from internal and external stakeholders regarding credentialing processes.
• Effective and timely completion of all credentialing-related audits and reviews.
• Strong team performance and development, with measurable improvements in team engagement and effectiveness.