Analyst, Market Strategy
•Scopely· 2h
Data ScienceFull-timeEurope
2h ago
Reklamehealth·about 1 month ago
Sixty million adults experience mental health challenges in the United States, yet one-third lack access to proper care. Opioid overdose is the number one cause of death for people under 50 in the United States.
We are a clinician-led, tech-enabled provider group that exists to provide culturally competent behavioral health care addiction care, medication management, crisis intervention, and care coordination for people working towards taking back control of their lives, while expanding access to care.
Our vision at ReKlame Health is to create a future where individuals who have historically been unable to access the care they deserve can readily obtain high-quality behavioral health and addiction care.
At ReKlame Health, it goes beyond mere employment; it's about becoming a part of a formidable movement transcending individuality. Let's unite and forge a world where health equity and effortless access to exceptional mental healthcare can co-exist.
We are seeking a detail-oriented Credentialing Specialist to join our team and ensure that all provider credentialing and licensure processes are conducted with the utmost accuracy and compliance. This role is vital to maintaining organizational efficiency and supports the onboarding and licensing needs of our providers.
The Credentialing Specialist will serve as the key coordinator for credentialing operations, liaising with payers, overseeing vendor workflows, and managing data with precision. The ideal candidate thrives in a structured, fast-paced environment and demonstrates keen organizational skills, exceptional attention to detail, and the ability to collaborate across teams. As the role grows, time will be split across credentialing, licensure, and provider onboarding needs to best support the practice.
Provider Credentialing & Re-Credentialing
Manage the full credentialing, enrollment, and re-enrollment processes for healthcare providers, including employment and payer enrollment with Medicare, Medicaid, managed care, and other commercial insurance networks.
Gather, review, and verify required documentation, including licensure, board certifications, DEA registration, malpractice insurance, and educational background, adhering to payer and organizational standards.
Submit accurate applications and follow up on status with payers, state licensing boards, and relevant agencies to ensure timely credentialing.
Provider Onboarding & Licensing Support
Coordinate the end-to-end onboarding process for new providers, ensuring all credentialing, licensing, DEA, and enrollment requirements are completed prior to start dates.
Prepare, submit, and track state license, DEA, and other required registrations or renewals, escalating issues and delays when necessary.
Maintain organized onboarding checklists and timelines so providers clearly understand requirements, expected dates, and next steps.
Collaborate with HR, operations, and clinical leadership to align start dates, system access, and schedule activation with credentialing and licensing milestones.
Support multi-state licensure efforts by tracking needs based on organizational expansion and payer requirements.
Documentation & Compliance
Maintain accurate provider records within credentialing databases (such as CAQH, health plan directories, and internal records), including credentialing and re-credentialing activities, expirable, and ongoing compliance documentation.
Track expiration dates for licenses, certifications, and insurance, ensuring uninterrupted provider participation in network contracts and federal programs.
Database & Systems
Use credentialing and enrollment software to organize workflows, track deadlines, and generate reports on provider enrollment and re-credentialing status.
Ensure provider data remains current in payer databases and internal systems, preventing enrollment status lapses and interruptions in reimbursement.
Payer Communication & Issue Resolution
Serve as the primary contact for credentialing and payer enrollment inquiries, working closely with providers and the billing team to communicate statuses and resolve issues.
Maintain relationships with payer representatives to expedite enrollment processes and ensure ongoing compliance.
Address requests for additional documentation or information from payers, acting as a liaison between providers and payer contacts as necessary.
Process Improvement
Identify and recommend improvements to streamline credentialing, licensing, and onboarding processes, reduce turnaround times, and increase efficiency.
Develop and implement credentialing and onboarding checklists, templates, and tracking tools for consistent, effective workflows and a clear audit trail for all actions.
Experience: Minimum of 2-3 years of experience in provider credentialing or payer enrollment, preferably in a hospital, behavioral health, or multi-specialty practice setting. Familiarity with Medicare/Medicaid enrollment is required.
Attention to Detail: Executes tasks with a high degree of accuracy, ensuring data is entered and reviewed meticulously to avoid errors. Proven ability to manage multiple deadlines effectively while maintaining precision and thoroughness in daily operations.
Problem-Solving Skills: Possesses strong problem-solving abilities to address issues like document discrepancies or delays in verification. Takes initiative to identify solutions efficiently with minimal guidance from supervisors, ensuring seamless credentialing workflows.
Communication Skills: Adept at building strong working relationships with providers and insurance entities through clear, professional, and empathetic verbal and written communication. Provides guidance to ensure a smooth credentialing process for all involved parties.
Accountability: Demonstrates a reliable work ethic by completing tasks consistently and communicating progress transparently. Takes personal responsibility for assigned work and understands the broader impact of their role on team operations.
Compliance Focus: Maintains thorough knowledge of credentialing protocols and regulatory standards. Regularly participates in required training to remain updated on compliance requirements and ensures immediate reporting and rectification of any discrepancies. Proactively ensures adherence to all established procedures to uphold organizational standards.
ReKlame Health considers several factors to ensure a fair and competitive offer when evaluating compensation packages. These include the scope and responsibilities of the role, the candidate's work experience, education, and training, as well as their essential skills. Internal peer equity is also examined to maintain balance within the organization. Additionally, current market conditions and overall organizational needs are crucial in shaping the final offer. Each aspect is thoughtfully reviewed before extending an offer, ensuring a comprehensive and equitable approach.
ReKlame Health is an equal opportunity employer. We celebrate diversity and are committed to creating a supportive and inclusive environment for all employees.
If you’re hungry for a challenge in 2025, love solving problems, and want to be a part of something transformational, we’d love to hear from you!
Learn more about us at www.ReKlamehealth.com
*We never ask for money or sensitive personal information during the job application process. If you receive an email or message claiming to be from us that requests such information, please do not respond and report it as a scam.