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Delegated Credentialing Specialist

Remote: 
Full Remote
Contract: 
Full time
Work from: 
Alaska (USA), California (USA), Colorado (USA), Idaho (USA), Oregon (USA), Texas (USA)

Offer summary

Qualifications:

3+ years of credentialing experience in a healthcare setting, with at least 1 year focused on delegated credentialing agreements., Strong understanding of NCQA standards and state Medicaid credentialing rules., Excellent organizational skills and attention to detail, with strong written and verbal communication skills., Experience working in behavioral health or outpatient care organizations, and familiarity with credentialing systems..

Key responsibilities:

  • Manage the full lifecycle of delegated credentialing for behavioral health providers, including initial credentialing and ongoing monitoring.
  • Ensure compliance with NCQA requirements and serve as the primary contact for delegated agreements with health plans.
  • Coordinate with various departments to ensure efficient credentialing and resolve issues with payor representatives.
  • Track and manage provider data accuracy and expirables to maintain eligibility and support quality assurance initiatives.

Headlight logo
Headlight Scaleup https://headlight.health/
201 - 500 Employees
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Job description

Join a team that’s transforming mental healthcare. Founded by psychiatrists, Headlight is more than a company: it’s a movement. A movement that exists on the front lines of the mental health crisis, transforming the way people access care and the way clinicians deliver it. In order to help people in their time of need and ensure that every person who comes to us has options, we are transparent about our capabilities, treatments, and coverage, we champion innovation, and we leverage our rich data to continuously implement better ways of delivering care. Our mission is simple but powerful: Improving lives, one session at a time. 

Our highly skilled and principled clinical team enjoys autonomy and institutional support so they can put their focus where it should be: on improving patient outcomes. Our clinicians want to do more than help individual clients, so they work to affect the system as a whole, elevating standards of care so that their efforts reverberate far beyond what they could do in private practice.

As the most trusted behavioral health partner in the Western U.S., we’ve established deep relationships that give us unparalleled access, interoperability, and first-priority referrals. This exclusivity, combined with our best-in-class coordinated care and feedback loops, results in superior outcomes and cost savings.

Our services are convenient, accessible, and expert, combining personalized client engagement with advanced technology to enhance, not replace, human connection. Indeed, we hold that human-to-human relationships are indispensable, so from the match to the session to the time between sessions, we provide whole person care so nobody falls through the cracks and there is a brighter path forward for all.

The Delegated Credentialing Specialist is responsible for managing and maintaining the delegated credentialing process for behavioral health clinicians across multiple markets. This role supports the organization’s compliance with NCQA, URAC, and payor-specific credentialing standards, while ensuring timely onboarding and maintenance of provider credentials. The Specialist will act as a liaison between payors, clinicians, and internal departments, playing a key role in sustaining our ability to deliver high-quality care by keeping our provider network active and in good standing. 

Our values
  • Deliver Excellent Service:We’re determined to deliver world-class care to our clients. We build long-lasting relationships because we’re intentional about the details of our delivery and quality of care. 
  • Make Mental Health More Accessible: Accessing mental health treatment shouldn’t be as hard as it is. We remove the barriers and simplify the process because it means our clients get the help they need, when they need it. 
  • Intentionally Listen: Communicate with empathy. We value deep understandings that create a healthy environment of collaboration, feedback and support. 
  • Learn and Grow: Every day is an opportunity to do better. We want to learn and grow. Our curiosity fuels our desire to improve our practice and process. As we learn and grow, we can help more people – which is what we’re all about. 
  • Communal Care: We help each other be the best by creating a culture of empathy, respect, growth and balance. 

    • Roles and Responsibilities
  • Own and manage the full lifecycle of delegated credentialing, including initial credentialing, recredentialing, and ongoing monitoring for W-2 employed behavioral health providers (therapists and prescribers). 
  • Ensure compliance with all NCQA credentialing requirements and state-specific regulations. 
  • Serve as the primary point of contact for all delegated agreements with contracted health plans. 
  • Maintain, audit, and submit credentialing rosters and reports to payors per delegated contract timelines. 
  • Support credentialing audits and file reviews from payors and regulatory bodies. 
  • Coordinate across Clinical Operations, Compliance, Talent Acquisition, and Revenue Cycle to ensure clinicians are credentialed and contracted efficiently. 
  • Interface directly with payor representatives to resolve issues related to roster acceptance, audit findings, or contract discrepancies. 
  • Support cross-functional initiatives to streamline credentialing data workflows between HRIS, CAQH, NPPES, and internal systems. 
  • Monitor and validate the accuracy of provider data in internal credentialing databases and rosters. 
  • Track and manage expirables (licenses, malpractice, DEA, board certifications, etc.) to ensure continued eligibility. 
  • Maintain provider files in accordance with credentialing best practices and privacy standards. 
  • Identify opportunities to improve credentialing turnaround time and data accuracy. 
  • Assist in developing SOPs, workflows, and training materials related to delegated credentialing. 
  • Participate in quality assurance reviews and performance improvement initiatives. 

    • Qualifications
  • 3+ years of credentialing experience in a healthcare setting, with at least 1 year focused on delegated credentialing agreements. 
  • Strong understanding of NCQA standards, state Medicaid credentialing rules, and commercial payor requirements. 
  • Experience working in behavioral health, mental health, or outpatient ambulatory care organizations. 
  • Proficient with credentialing systems (e.g., Modio, CAQH, Availity, or similar). 
  • Excellent organizational skills, attention to detail, and the ability to meet strict deadlines. 
  • Strong written and verbal communication skills. 
  • Experience supporting a multi-state provider network. 
  • Knowledge of Medicare/Medicaid enrollment processes. 
  • CPCS or CPMSM certification (or working toward it). 
  • Familiarity with EHR systems and provider onboarding workflows. 

    • Benefits
  • Competitive Hourly Compensation
  • Full benefits including health, dental, vision, 401(k), and paid time off 
  • Opportunity to join a purpose-driven, high-growth leadership team at a pivotal moment in behavioral healthcare transformation 
  • Professional development opportunities and training
  • Collaborative and supportive work culture.
    • Not meeting all the requirements? Research indicates that women, communities of color, and historically underrepresented individuals are often hesitant to apply for jobs unless they meet every qualification. We are committed to cultivating a diverse, inclusive, and genuine workplace. If you're enthusiastic about this position but your previous experience doesn't precisely match every qualification listed, we enthusiastically encourage you to submit your application. You could be the ideal candidate for this role or others!

    Headlight is committed to the principles of diversity, equity, and inclusiveness and seeks to create a working environment reflective of this commitment. We seek to provide a diverse clinician base to support the diversity of our clients. Headlight supports and respects diversity of people, culture, and ideas throughout our organization. Headlight thrives to be a welcoming, diverse and discrimination- and harassment-free workplace.

    By applying for this position, you consent to receive future communications from Headlight via email or text regarding this application and related employment opportunities. You may opt-out at anytime by contacting us directly.

    Job Postings on Indeed and other job boards may post with total compensation (base + bonus). For the exact base salary range please check our website or our job-site

    Required profile

    Experience

    Spoken language(s):
    English
    Check out the description to know which languages are mandatory.

    Hard Skills

    Credential ManagerCompliance ManagementBehavioral HealthProvider Data ManagementEmployee OnboardingCredential ManagerPhysician CredentialingCerner EHR

    Other Skills

    • Organizational Skills
    • Communication
    • Time Management
    • Detail Oriented
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