Delegated Credentialing Specialist

Tava Health • Salt Lake City, UT

8d

About The Position

The Delegated Credentialing Specialist owns day-to-day execution of Tava Health’s delegated credentialing program across assigned payer relationships. The role manages payer audits, compliance reporting, audit-ready credentialing files, corrective action plans, provider-data reconciliation, and credentialing operations while partnering with internal teams and delegated entities. The specialist also supports day-to-day credentialing for Nurse Practitioners and group practices.

The position oversees delegated credentialing activities, monitors regulatory and accreditation updates, prepares and facilitates audits, maintains credentialing records, and serves as a contact for payer communications. It also leads operational preparation and follow-through for Credentialing Committee meetings, leads credentialing for Nurse Practitioners, and supports credentialing for group practice providers.

Requirements

• 2–5 years of credentialing and enrollment experience, including at least 2 years specifically focused on delegated credentialing.
• Certified Provider Credentialing Specialist (CPCS) certification.
• Ability to manage multiple payer relationships and responsibilities with minimal oversight.
• Self-motivated team player who thrives in a multitasking environment and can adjust priorities.
• High attention to detail, strong organization, and excellent documentation skills.
• Outstanding written and verbal communication.
• Familiarity with CAQH, NPDB, PECOS, state licensing resources, credentialing software, and payer rostering tools.

Nice To Haves

• High-growth or tech-enabled healthcare background.
• Behavioral health experience.

Responsibilities

• Oversee delegated credentialing activities for an assigned payer portfolio, including readiness reviews, ongoing compliance monitoring, recurring reporting, and annual audits.
• Monitor NCQA guidance, state regulations, and other accreditation updates; 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.
• Develop and track corrective action plans through resolution.
• 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.
• Monitor average time to credential, identify delays, manage follow-up, and escalate issues as needed.
• Partner with Enrollment, Partnerships, Revenue Cycle, Legal/Compliance, and other teams to maintain accurate provider data and reconcile internal records against delegated payer rosters.
• Serve as a point of contact for payer communications related to delegated credentialing activities, audits, provider records, and follow-up items.
• Support implementation of new delegated credentialing agreements, including processes and controls needed to fulfill contractual requirements.
• Lead operational preparation, execution, and follow-through for Credentialing Committee meetings in consultation with the Committee Chair.
• Curate and maintain accurate Credentialing Committee meeting minutes, training materials, committee records, and follow-up items.
• 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.

Benefits

• Competitive salary and stock options.
• Fully covered medical and dental premiums for the employee and family, plus voluntary insurance options.
• Free, generous Tava mental health benefit.
• Monthly HSA contributions for qualifying enrolled employees.
• Generous PTO and paid holidays.
• Paid parental leave.
• 401(k) retirement plan.
• Weekly company-paid lunch via DoorDash and a personal DashPass subscription.
• Opportunity to make a meaningful impact at a high-growth, mission-driven company.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed