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This role manages the day-to-day operations of the credentialing function, ensuring compliance with health plan and NCQA requirements. It also involves providing leadership to the credentialing team and overseeing delegated credentialing processes for affiliated entities.
About Altais:
At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.
Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.
About the Role
Are you looking to join a fast-growing, dynamic team?
We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.
This role is responsible for the direct supervision of day-to-day operations of the credentialing function to support the delegated function for all our Health Plan Partners, supporting credentialing efforts for all lines of business. This role manages the credentialing program for Altais affiliated entities, including BTP employed clinicians, vendors providing clinical services on the MSOs behalf, as well as MSO services for any other medical group or IPA purchasing from Altais Health Solution. This role is also responsible for the administrative aspects for all credentialing functions needed to meet medical group, health plan and National Committee for Quality Assurance (NCQA) requirements. This role, in combination with the rest of the Credentialing team is to maintain, develop and implement credentialing processes, procedures and processes in line with all regulation and compliance requirements. Additionally, this role will oversee the interdependencies between departments, consistently maintaining knowledge and understanding of the impact to providers and how that may affect the Credentialing team moving forward.
You will focus on:
Providing leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner
Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations
Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
Manages relationships with health plan delegation oversight committee members.
Manages process for initial and re-credentialing review by Clinical Advisory Group for exception physicians
Manages claims and appeals and peer review physician documentation for Clinical Advisory Group
Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database
Owns end to end delegated credentialing process
Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services.
Identifies and resolves technical, operational and organization problems outside own team
Serves as SME for business requirements for sPayer
The Skills, Experience & Education You Bring
Bachelor’s degree or equivalent to 4 year university degree, preferably in healthcare related field of study.
5+ years professional experience working in credentialing, in a managed care setting required.
1+ year of management experience in Credentialing
Required Certifications
Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within 18 months of employment
NAMSS Credentialing certification preferred.
The Base Salary for this position is $62,250 - $80,000/yr
In addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
Excellent medical, vision, and dental coverage
401k savings plan with a company match
Flexible time off and 9 Paid Holidays
You Share Our Mission & Values:
Compassion
We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.
Community
We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.
Leadership
We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.
Excellence
We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.
Agility
We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.
Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
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