Credentialing Specialist

Alma • Angle, MN

9h • Remote

About The Position

Alma is on a mission to simplify access to high-quality, affordable mental health care. We do this by making it easy and financially rewarding for therapists to accept insurance and offer in-network care. When a provider joins Alma, they gain access to a suite of tools that not only help them better run their business, but also grow it sustainably and develop as a provider. Alma is available in all 50 states, with over 20,000 therapists in our growing network. Anyone looking for a therapist can browse Alma’s free directory. Alma has raised $220.5M in funding from Insight Partners, Optum Ventures, Tusk Venture Partners, Primary Venture Partners, First Round Capital, Sound Ventures, BoxGroup, Cigna Ventures, and Rainfall Ventures. Alma was also named one of Inc’s Best Workplaces in 2022 and 2023.

Requirements

• 4+ years of hands-on healthcare credentialing experience, including directly managing processes end-to-end (Behavioral Health experience is a major plus).
• Solid understanding of NCQA standards and the primary source verification process.
• Proficiency with CAQH and experience working with a CVO.
• Bachelor’s degree preferred, or equivalent years of specialized experience.
• You have a "no stone left unturned" approach to data. You enjoy the puzzle of matching payer requirements with provider documentation.
• You can translate complex "credentialing-speak" into simple instructions for providers and internal stakeholders.
• You are comfortable navigating Credentialing Software, Zendesk, or Salesforce and can quickly learn new internal tools.
• As a Level 3, you don't need a playbook for every scenario; you can research state-specific regulations and propose a path forward.

Nice To Haves

• CPCS (Certified Provider Credentialing Specialist).

Responsibilities

• Manage the full credentialing and re-credentialing cycle for providers across delegated and non-delegated payer arrangements.
• Ensure all provider files (Licensure, DEA, Board Certs, Malpractice) are verified and maintained in accordance with NCQA standards.
• Serve as the internal expert on CAQH ProView; ensure provider profiles are accurate, attested, and synchronized with internal databases.
• Act as the primary day-to-day contact for our CVO partners, monitoring their SLAs and auditing their work for accuracy before committee review.
• Proactively track and manage upcoming expirations for licenses and certifications to prevent provider "dark time" or insurance department.
• Execute monthly checks against OIG, SAM, and Medi-Cal/Medicaid sanction lists; investigate and document any "flags" for Manager review.
• Prepare high-quality credentialing packets and summary reports for the Credentialing Committee to ensure efficient decision-making.
• Partner with the Revenue Cycle Management (RCM) team to troubleshoot claim denials linked to credentialing or enrollment errors.
• Identify repetitive manual tasks within the credentialing funnel and suggest automation or process shifts to increase "speed to lead" for new providers.

Benefits

• Health insurance plans through Aetna (medical and dental) and MetLife (vision), including FSA and HSA plans
• 401K plan (ADP)
• Lifestyle Spending Account for health, wellness, and family care
• Monthly co-working space membership stipend
• Monthly work-from-home stipend
• Financial wellness benefits through Northstar
• Pet discount program through United Pet Care
• Financial perks and rewards through PerkSpot
• EAP access through Aetna
• One-time home office stipend to set up your home office
• Inclusive family and medical leave plans
• 12 paid holidays and 1 Alma Give Back Day
• Flexible PTO

What This Job Offers

• Job Type: Full-time
• Career Level: Senior