About Our CompanyAt Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include: Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.
About Your Team
Are you looking to work with a high performing, fast growing and dynamic Credentialing Team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.
About Your Work
The Director of Credentialing develops processes and procedures driving application management, intake, credentialing, re-credentialing, expirable data management and delegated credentialing contract process to ensure compliance with National Committee for Quality Assurance (NCQA), CAQH standards, CMS, state and federal regulations and individual health plan requirements. The Director will be responsible for credentialing analysis, quality assurance, planning and forecasting, client/vendor relationships and continuous improvement of operational performance. The Director of Credentialing leads and mentors a team responsible for services throughout 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. They will work cooperatively with staff, physicians, leadership, department directors and vendors.
The Director of Credentialing establishes the operations of the provider credentialing functions by developing Credentialing related organizational policies and procedures. The Director of Credentialing will ensure compliance with company policies, regulatory compliance, manage employees, meet expectations of customers, and achieve operational goals and objectives. This role will lead delegated functions for all our Health Plan Partners for all lines of business as well as all oversight and audit components are critical functions of this position including developing and execution of remediation plans.
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. The leader will champion increased provider satisfaction by working with Provider Services, Contracting and Network Development to expedite the contracting process and deliver best in class service. The Director will leverage technology to drive automation and efficiencies across the department.
The Director will be involved in high-level decision-making processes such as setting long-term goals, leading initiatives and will have the ability to manage plans as new customers or IPAs are contracted while understanding the impact to staffing, monthly trends and onboarding.
You will focus on:

• Provide leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner
• Responsible for the oversight of 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
• Owns end to end delegated credentialing process
• Direct 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 committee members.
• Leads process for initial and re-credentialing review by the Credentialing Committee and the Clinical Advisory Group for exception physicians
• Conduct on-going program evaluations and audits of data integrity
• Identifies opportunities and root-cause to improve the credentialing process and use of technology; identifies and resolves technical, operational and organization problems outside own team
• Lead appeals and peer review physician documentation for the Credentialing Committee and the Clinical Advisory Group
• Oversee provider health plan enrollment for employed physicians
• Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions
• 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
• Responsible for provider data integration of newly acquired entities or new customers including software and staff, ensures smooth transition of providers when on-boarding, for new contracts and during acquisitions
• Develop monthly management reports illustrating status, back-log, and trends to be used at Monthly Operating Review
• Manages staff including interviewing and selecting qualified candidates, coaching for career development, training, monitor productivity and accuracy, conducting performance evaluations, addressing guidelines and changes, consistent application of HR policies and procedures, and guide staff to confident decision-making
• Serves as SME and provides strategic direction for business requirements for s Payer
• Support, participate and contribute to the development and growth of credentialing functions
• Assumes responsibility for own personal continuing education and developmental needs; attends meetings, workshops to enrich personal knowledge, growth, and management skills.
• Demonstrates the ability to be flexible, organized and function under stressful situations. Fosters good public relations for the company and the client

The Skills, Experience & Education You Bring

• Bachelor’s degree or equivalent to 4-year university degree, preferably in healthcare related field of study.
• 10+ years professional experience working in credentialing, preferably in a managed care setting required.
• s Payer (e VIPs, Cactus) credentialing experience
• Minimum of 10 years of combined management, credentialing, or regulatory affairs experience, preferably in a managed care or insurance environment. Ability to work with physicians in a collaborative manner.
• Certified Provider Credentialing Specialist (CPCS) and Certified Professional in Medical Staff Service Management (CPMSM) is preferred.
• Experience with and knowledge of CAQH and credentialing processes.
• Knowledge of delegated credentialing and verification
• Knowledge of related accreditation and certification requirements
• Knowledge of medical credentialing procedures and standards
• Ability to create, implement, document and audit policies and procedures
• Manage both direct and indirect remote employees and ensures internal controls are followed
• Ability to effectively prioritize and execute tasks in a high-pressure environment
• Ability to lead and manage others, strong interpersonal, project management and mentoring skills
• Lead Health Plan audit activities
• Experience presenting to leadership – outlining plans for future success
• Ability to develop management reports
• Independently resolve issues and to develop solutions for existing problems to be escalated to internal leadership where appropriate
• Worked with Management Services Organization (MSO), Health Plan or large at-risk provider practice; and IPA or medical groups
• Understand the use credentialing software and automation to improve workflow
• Oversees the supervision of personnel which may include work allocation, training, enforcement of internal controls; evaluates performance and motivates employees to achieve peak productivity and performance
• Understands how to support growth and scale as the organization grows customers
• Ability to work with internal stakeholders to develop technical solutions to improve accuracy and efficiency of processes and reporting
• Excellent communication skills, both written and verbal, as well as strong organizational and administrative abilities
• Advanced Excel knowledge is required

Preferred Experience:

• 10+ years professional experience working in credentialing, with 3+ years of employee / team management experience preferred.

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.