About the Role

As the Credentialing Specialist, you will own all aspects of credentialing including data management: individual applications, group applications, PTAN applications (new and reassignments), payer portal attestations, and maintenance as needed. You will be responsible for updating and maintaining our credentialing data warehouse to ensure all documentation is up to date, developing and submitting the w2 employee roster and 1099 contractor roster. You will work with the clinical team as needed to acquire documentation and ask any questions that come up during the credentialing process. This role will report to the Sr. Director of Compliance and Regulatory Affairs.

About Season

Season Health is the only integrated clinical nutrition solution that drives engagement, outcomes and cost of care reduction across populations, powered by its food-as-medicine platform. With one of the largest networks of registered dietitians and a curated food market of national and local vendors, Season empowers individuals and their families to make informed, sustainable choices, measurably improving both health outcomes and quality of life. Learn more at www.seasonhealth.com 

Responsibilities

• Completing and submitting individual, group applications
• Payer Portal attestations and maintenance
• Full cycle credentialing process: Payer contract review; primary source verification; submitting providers names, adding them to and verifying COI; reviewing entire CAQH profiles and updating it, reviewing and updating PECOS, putting together entire provider file, verifying completeness and accuracy, applying for PTANs; developing relationships with providers and payers.
• Manage onboarding from onboarding to CV/PSV to PECOs, CAQH and submission
• Updating and maintaining our credentialing data warehouse
• Developing W2 employee roster and 1099 contractor roster and submitting on payer websites.
• Highlighting any significant errors found in Portals, Contracts, Provider Data, Rosters, and working through solutions to correct them. 
• Managing panel status, application status, etc. as needed by calling and interacting with Health Plans.

About You

• Full circle knowledge of the credentialing process and credentialing terminology. 
• In-depth knowledge of the enrollment process
• Experience with multi-state credentialing of at least 5 different States or more (a mix of CPOM and non-CPOM States preferred)
• Hands-on experience updating PECOS, CAQH, and CAQH ProView, as well as applying for PTANs
• Experience creating rosters for different payers (Blue plans, Aetna, United, Medicaid preferred)
• Knowledge of Post-contract execution EDI/ERA/EFT setup
• Experience with individual provider and group credentialing
• Experience with Verifiable, Medallion or another CVO a plus
• 5+ years experience communicating with health plans to facilitate credentialing
• 5+ years experience with CAQH, Availity and Payer Portals required
• Active experience with Google workspace and Excel, and utilizing Slack for communication
• A comfort and familiarity with tech with the ability to pick up new platforms with ease
• Exceptional written and verbal communication skills, with an attention to detail when compiling documentation
• A self-starting mindset and high sense of ownership; you readily identify blockers to progress as well as opportunities for improving existing ways of doing things. 
• An ability to learn quickly and have a comfort with ambiguity and a faster pace of working. Start-up experience a plus.

Compensation and Benefits

• The salary range for this role is $22-28/hr commensurate with experience
• This is a temporary, full time position (~60 days) in a fully remote environment
• Flexible work arrangements and accrued paid time-off (sick and vacation)
• An opportunity to use your skills to help improve nutrition and population health at a mission-driven company

Interested? How to Apply:

To apply, please send us your resume (no cover letter is required). If selected, you will be invited to a :30 minute phone screen to get an overall sense of your experience. Following a successful phone screen, you will be asked to return for 2 rounds of interviews to assess more indepth your technical skill, knowledge, and working style.

More about Season

Season is a series-A stage business backed by Andreessen-Horowitz, LRV Health, 8VC, Bain Capital, Healthy.VC and Grand Central Tech among others. 

Season recruits, employs, compensates, and promotes regardless of race, religion, sex, national origin, ethnicity, gender identity, disability, age, veteran status and other protected status as required by applicable law and as a matter of our company ethics.