Senior Credentialing Analyst

About us:

Duet empowers Nurse Practitioners (NP) to tackle the primary care crisis by leading their own practices, closing the gap in access while keeping care local. We're a well-funded seed-stage company led by experienced entrepreneurs and Nurse Practitioners, and backed by investors like Lerer Hippeau and Kairos.

We’re building a vertically integrated platform for NP practices to thrive as standalone businesses in a time of corporate consolidation. Think of workflows to engage patients, streamline administration, forecast business growth, and drive high-quality care and value-based outcomes while building community among NPs. These solutions sit on a foundation of data that we harness across patients and providers for the benefit of care and business success.

About the role:

We are looking for Duet’s first credentialing hire to drive our credentialing operations and ensure excellence in quality and compliance. This individual is responsible for handling and coordinating the credentialing process for new and established providers at Duet. They will oversee and engage in the preparation of correspondence, gathering payer credentialing paperwork, and filing through the insurance carriers for new and re-certification. They will develop credentialing policies and procedures designed to ensure efficient work flows and ensure compliance with applicable regulatory and accreditation agencies. This role is remote and will report into the COO.

Key Responsibilities:

• Oversees the end-to-end credentialing process for our network of nurse practitioners

• Develops, implements, and continuously improves credentialing, re-credentialing, and privileging processes, policies, and procedures to ensure compliance with regulatory requirements.

• Audits and assesses the effectiveness and efficiency of both delegated and non-delegated credentialing end-to-end processes.

• Conducts thorough investigations and verifications of healthcare providers' credentials by directly contacting primary sources.

• Collaborates on, coordinates and supports credentialing committee activities, including scheduling, preparation, facilitation, and documentation of meetings.

• Ensures compliance with and stays abreast of changes to legal and regulatory standards, including NCQA and National Practitioner Data Bank guidelines.

• Leverages technology platforms and software systems to streamline credentialing processes, maintain records, and enhance efficiency.

• Facilitates and participates in payor meetings.

• Collaborate with RCM on credentialing and enrollment related claims projects and denials.

Qualifications

• 3+ years experience in provider credentialing and privileging processes

• Early-stage startup background preferred

• Primary care setting experience and familiarity with EHRs, billing/coding systems, and value-based care preferred

• Demonstrated knowledge of credentialing principles, industry regulations, state and deferral law, and accreditation standards

• Strong project management and organization skills

• Experience with credentialing platforms and related software

• Bachelor's Degree, preferable in a related area of study