Licensing and Credentialing Specialist
Company Description:
Quartet is a leading tech-enabled behavioral health company that works with health plans, systems, and provider groups to deliver speed to quality behavioral health care for all. Through sophisticated data and analytics, along with personalized services, Quartet exists to advance quality care as defined by four measures: speed to care, seamless patient experiences, improved health outcomes, and affordability. The company is backed by venture funding from top investors including Oak HC/FT, GV (formerly Google Ventures), F-Prime Capital Partners, Polaris Partners, Deerfield Management, Echo Health Ventures, Centene Corporation, and Independence Health Group.
We are deeply committed to growing a diverse team and an equitable and inclusive culture where all Quartetians are empowered to be themselves and do their best work. We know this is vital in realizing our mission to improve the lives of people with mental health conditions.
About the team & Opportunity:
Quartet is seeking a Licensing & Credentialing Specialist to support the licensing and credentialing process for our clinical providers. Partnering closely with the care team, the Licensing & Credentialing Manager plays a key role in our ability to scale patient services and increase access. The ideal candidate will be responsible for ensuring that all healthcare professionals within our organization are properly licensed and credentialed to practice in accordance with state regulations and organizational standards. This position requires strong attention to detail, a proactive orientation to supporting our care team, and excellent task management skills.
Job Responsibilities
Licensing
- Support provider setup and licensing for new clinical hires
- Manage the end-to-end process of licensing applications, ensuring completeness and accuracy of documentation for our clinicians, including nurses, nurse practitioners, social workers, therapists, and physicians
- Track and manage state license renewals, as well as compact renewals where necessary
- Monitor and update licensing information to reflect status and changes
- Research and interpret state and federal regulations governing mental health services licensure to stay up to date with the latest regulations
- Develop and maintain a comprehensive understanding of licensing requirements across multiple jurisdictions to ensure compliance as the company expands geographically
Credentialing
- Coordinate the initial credentialing and re-credentialing processes for licensed providers, including reviewing and verifying education, training, licensure, and professional experience to ensure adherence to organizational standards and regulatory requirements.
- Track and manage all provider credentialing as we add new payor contracts and expand to new states.
- Monitor and update credentialing information to reflect status and changes.
- Maintain a comprehensive database of provider credentials, ensuring accuracy and compliance with organizational policies and relevant regulations.
- Support payor enrollment activities where required to ensure providers are properly set up in payor systems.
Documentation and Compliance
- Maintain accurate and up-to-date records of all licensing, credentialing, and privileging activities, including documentation of compliance with regulatory standards.
- Conduct regular audits and reviews of licensing and credentialing records to identify discrepancies, gaps, or potential areas of non-compliance.
- Provides support for interpretation, development, and implementation of all systems and functions to ensure continuous compliance with state and federal law, organization policies, regulatory agencies and accrediting body standards.
Cross-functional Collaboration
- Collaborate closely with internal stakeholders, including clinical operations, legal, human resources, and finance teams, to ensure alignment of licensing and credentialing activities with organizational goals and objectives.
- Serve as a subject matter expert on licensing and credentialing matters, providing guidance and support to internal teams as needed.
Delegated Credentialing
- Lead the oversight of all delegated activities to ensure compliance with CMS, and NCQA requirements.
- Responsible for ensuring thorough preparation of documentation, reports and any other information needed for regulatory and NCQA audits related to delegation oversight.
- Coordinate communication with delegates regarding regulatory and NCQA audits.
- Implement and maintain a comprehensive delegation oversight program which supports all aspects of credentialing delegation.
- Monitor delegates and internal business owner relationships to ensure compliance and optimal delegate performance and achievement of business goals according to service level and other contractual requirements.
- Responsible for the management of delegation performance, including monthly, quarterly, annual performance reporting and Corrective Action Plans (CAP)
- Direct pre-delegation audits, annual audits, required reporting and ongoing oversight of delegates.
- Lead the development and maintenance of delegated related policies and procedures.
- Initiate implementation of new or changed regulatory and/or accreditation requirements to ensure the adequacy of controls of oversight activities.
- Chair the Delegation Oversight Committee and taking appropriate committee minutes
- Collaborates with payor, compliance, and RCM leaders in support of an ongoing performance improvement and reporting process that is accurate, timely and action driven.
- Provides ongoing communication with leaders especially in regard to risk/issues identified during the credentialing/recredentialing process for delegated credentialing.
- Contributes and supports technology integration and migration with other system information systems
- Supports completion of regulatory and accreditation surveys.
- Supports education, professionalism, practice-based learning and systems-based learning
- Provides initial orientation and ongoing education to designated team members on delegated credentialing processes, software, self-audits, and other education as needed
Required Skills and Qualifications
- Bachelor’s Degree in related fields with a minimum of 4 years’ experience required
- 3-5+ years administrative experience in healthcare setting is preferable
- Experience with licensing or credentialing (with varying provider types) required; specific experience with therapists, nurses, nurse practitioners, and medical doctors preferred
- Thorough knowledge of state and federal regulations related to mental health licensure, credentialing, and privileging requirements
- Very strong attention to detail and outstanding organization skills
- Excellent task management and communication skills, ability to work successfully across diverse teams
- Proficient using G-suite tools
- Comfort and familiarity with provider licensure and credentialing software (Medallion Preferred)
Our Benefits
We're proud to offer the following benefits to our team members:
- All roles are fully remote
- Competitive compensation
- An unlimited PTO policy and paid holidays
- Paid parental leave
- Robust medical, dental and vision insurance plans
- A 401(k) plan with employer match
- Mental health benefits via our EAP
- 100% employer-paid life insurance, short-term and long-term disability insurance
- Annual learning & development budget
Compensation
The expected salary range for this position is $80,000 - $90,000 with an additional 5% annual bonus potential.
Want to know what Quartet life is like? Click here to meet our team.
Quartet actively encourages applicants of all backgrounds to apply and is proud to be an equal opportunity employer. We do not discriminate on the basis of race, color, ancestry, religion, national origin, sexual orientation, age, citizenship, marital or family status, disability, gender, gender identity or expression, pregnancy or caregiver status, veteran status, or any other legally protected status. To perform this job successfully, an individual must be able to perform essential job duties - reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions. If you require assistance in completing this application, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to talent@quartethealth.com
Have someone to refer? Email talent@quartethealth.com to submit their details to us.
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