Senior Manager, Credentialing

About Altais:
At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists.

Together, we’re building a stronger, more connected healthcare system.

This role is responsible for the strategic direction and operational oversight of the credentialing function to support, develop, manage and monitor processes and procedures for the credentialing, re-credentialing, expirables data management and delegated functions for all our Health Plan Partners for all lines of business. This role manages the credentialing program for Altais 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 purchasing from Altais Health Solution including application management and primary source verification completion.

This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and accrediting body requirements including but not limited to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), and the Department of Managed Health Care (DMHC). This role, in combination with the Credentialing team, is to maintain procedures, processes and internal & vendor systems in line with all regulation and compliance requirements.

This role has key vendor management oversight responsibilities to ensure our contracted vendor systems and services are delivering services and capabilities as expected. 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. At the senior level, this role owns the credentialing policy portfolio, the development and maintenance of departmental training documentation, preparation and facilitation of the Credentialing Committee, pre-delegation and ongoing oversight audits of sub-delegated entities, and the development of key performance indicators and executive reporting for the function.

You will focus on:

• Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timel
• Responsible for 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
• Manages 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 teams
• Manages peer review physician documentation for Clinical Advisory Group
• Develops, maintains, and annually reviews credentialing training documents, desktop procedures, and onboarding materials for the credentialing team
• 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
• Owns Credentialing Database system modifications and workflows development and…