Delegated Credentialing Specialist

Tava Health Connecticut, Connecticut, US

About the Role

ABOUT TAVA At Tava Health, we believe mental health care should be as accessible and stigma-free as a checkup. We’re a fast-growing team on a bold mission: to make high-quality mental health care available to everyone. If you’re passionate about using technology to solve meaningful problems and create lasting change, we’d love to meet you.
The Delegated Credentialing Specialist owns the day-to-day execution of Tava Health’s delegated credentialing program across assigned payer relationships. This role manages payer audits, compliance reporting, audit-ready credentialing files, corrective action plans, provider-data reconciliation , and credentialing operations while partnering closely with internal teams and delegated entities. The role also supports day-to-day credentialing for Nurse Practitioners and group practices.
Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits.
assess operational impact and implement necessary compliance changes.
Prepare for and facilitate pre-delegation and annual credentialing audits in accordance with NCQA and payer-specific requirements; Maintain complete, audit-ready credentialing records, including primary source verification, Credentialing Committee documentation, and adverse action logs.
Prepare recurring deliverables for delegated partners and payers, such as provider rosters, audit materials, and credentialing activity reports.
Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and routinely reconcile internal records against delegated payer rosters.
Serve as a reliable point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items.
Support the implementation of new delegated credentialing agreements, including the processes and controls needed to fulfill contractual requirements.
Credentialing Committee
Serve as the operational lead for Credentialing Committee meetings in consultation with the Committee Chair, owning meeting preparation, execution, and follow-through.
Curate and Maintain accurate Credentialing Committee meeting minutes, training materials, committee records, and follow-up items.
NP and Group Practice Credentialing
Lead credentialing for Nurse Practitioners, including application review, primary source verification, committee readiness, payer submissions, follow-up, and status tracking.
Support credentialing for group practice providers by coordinating documentation, resolving application gaps, monitoring timelines, and maintaining accurate provider records.
2–5 years of credentialing and enrollment experience, including at least 2 years specifically focused on delegated credentialing.
~ Certified Provider Credentialing Specialist (CPCS) certification.
~ Familiarity with CAQH, NPDB, PECOS, state licensing resources, credentialing software, and payer rostering tools.

Competitive salary and stock options (so you share in the company’s success).
~ Fully-covered medical and dental premiums for you and your family, plus voluntary insurance options.
~ Generous PTO and paid holidays.
~ 401(k) retirement plan.
~ Weekly company-paid lunch via DoorDash and a personal DashPass subscription.
~ For tax purposes, priority will be given to candidates living in states where we already have employees. Tava is unable to sponsor employment visas (such as the H-1B). Please beware of unauthorized recruiting communications requesting personal information. We never hire anyone without first completing a real-time, face-to-face interview (conducted by video or in-person), nor do we use encrypted instant messaging services like Signal. If you have questions regarding the authenticity of any outreach, please do not hesitate to use the chat feature on our website or contact us at Health does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity, or any other reason prohibited by law in provision of employment opportunities and benefits.

Responsibilities

  • Oversee delegated credentialing activities for an assigned payer portfolio
  • Maintain audit-ready credentialing records
  • Partner with internal teams to reconcile provider data

Qualifications

  • NCQA and payer-specific credentialing audits
  • adverse action logs
  • provider data reconciliation

Required Skills

credentialing compliance data governance audits provider data

Keywords

credentialing delegated credentialing payer audits provider data compliance

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Job Overview

Date Posted 4 days ago
Location Connecticut, Connecticut, US
Job Type Full-time
Work Mode Remote
Category Healthcare clinical nursing

About the Company

Tava Health