Credentialing Specialist

📋 Description

• • Sailor Health is at the forefront of addressing a critical gap in healthcare: the mental health crisis among older adults. Recognizing that this demographic faces the highest suicide rates while receiving the least mental health care, Sailor Health is dedicated to building a comprehensive platform that revolutionizes senior mental health services. Our mission is to connect older adults with therapists, healthcare professionals, and insurance plans, creating a seamless ecosystem for care delivery and management. By 2030, with over 65 million seniors representing nearly a quarter of the U.S. population, the need for specialized mental health solutions for this age group is more urgent than ever. Sailor Health is actively partnering with Medicare to provide accessible and high-quality psychotherapy to hundreds of patients, demonstrating our commitment to tangible impact.
• • As a full-time remote Credentialing Specialist, you will play a pivotal role in ensuring that Sailor Health can effectively deliver care by managing and optimizing our provider credentialing processes. This role is crucial for our operational success and our ability to scale our services. You will be responsible for the end-to-end enrollment of both individual providers and practice locations within Medicare, specifically through the PECOS system, which is a cornerstone of our payer network. Your expertise will extend to managing the credentialing process with various Medicare Advantage health plans, ensuring our providers are recognized and reimbursed.
• • A key aspect of your responsibility will be the meticulous maintenance of CAQH profiles. These profiles are vital for accurate provider data and efficient claims processing. You will ensure that all information is complete, up-to-date, and accurately reflects the credentials and practice details of our healthcare professionals. This requires a keen eye for detail and a systematic approach to data management.
• • Beyond managing existing processes, you will be instrumental in driving innovation and efficiency. This includes assessing our current credentialing workflows, identifying areas of inefficiency, and implementing improvements. You will leverage tools such as Airtable and other automation technologies to streamline these processes, making them more robust and scalable. The development and maintenance of Standard Operating Procedures (SOPs) will be a core part of your role, establishing clear guidelines for all credentialing functions and ensuring consistency across the organization.
• • You will also be responsible for monitoring compliance and ensuring uninterrupted provider participation in payer networks. This involves diligently tracking credentialing statuses, upcoming re-credentialing deadlines, and staying abreast of any changes in payer requirements or notices. Proactive management in this area is essential to prevent disruptions in service delivery.
• • Collaboration is key in this role. You will work closely with various internal teams, including Clinical Operations, Payer Strategy, and Provider Growth. By aligning priorities and sharing regular updates on credentialing progress, potential blockers, and successes, you will ensure that all departments are informed and working cohesively towards our shared goals.
• • Furthermore, you will serve as a primary point of contact for credentialing-related inquiries, both for our providers and internal teams. This involves providing clear guidance, answering questions, and coordinating the submission of necessary documentation, ensuring a smooth and supportive experience for all stakeholders.
• • This role offers a unique opportunity to shape the operational backbone of a rapidly growing company focused on a deeply meaningful mission. You will have significant ownership and the chance to make a direct impact on our ability to serve the senior population.