Credentialing ManagerDirector
Credentialing ManagerDirector
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
- Develop implement and enforce policies and procedures for credentialing and payer enrollment across all states and markets.
- Oversee the full lifecycle of credentialing and recredentialing for providers ensuring accuracy compliance and timeliness.
- Lead mentor and manage credentialing and enrollment staff including performance management training and team development.
- Ensure accurate up-to-date provider data in internal systems and payer portals
- Monitor and maintain compliance with CMS NCQA URAC federal/state regulations and payer-specific requirements.
- Collaborate cross-functionally with finance contracting revenue cycle legal operations and clinical leadership to support timely provider onboarding and billing readiness.
- Serve as the primary point of contact for escalated issues with payers regulatory agencies and partner practices.
- Maintain strong relationships with payer representatives and credentialing contacts.
- Provide regular status updates and reports to executive leadership including key performance indicators (KPIs) risk areas and opportunities for process improvement.
Qualifications :
- Bachelors degree required in healthcare administration business or related field; Masters degree preferred.
- Minimum 5 years of experience in non-delegated healthcare credentialing and payer enrollment with at least 2 years in a leadership capacity.
- Deep understanding of credentialing standards payer enrollment protocols and federal/state regulatory requirements.
- Hands-on experience with PECOS CAQH NPPES Availity and other credentialing/enrollment platforms.
- Demonstrated ability to lead coach and develop high-performing teams in a fast-paced environment.
- Excellent communication organizational and problem-solving skills.
- Technically proficient with Microsoft Office and credentialing management systems (e.g. Verity Medallion Modio or similar).
- Proven ability to manage confidential and sensitive information with discretion.
Additional Information :
Job Type:
- Full-time
- #LI-SF1
- #LI-REMOTE
Education:
- Bachelors Degree (Required)
- Masters Degree (Preferred)
All your information will be kept confidential according to EEO guidelines.
Integrated Dermatology and its entities provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.
This policy applies to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absence compensation and training.
Remote Work :
Yes
Employment Type :
Full-time
Employment Type
Remote
Company Industry
Department / Functional Area
Legal
Key Skills
- Fundraising
- Management Experience
- Coaching
- Analysis Skills
- Strategic Planning
- Team Management
- Budgeting
- Leadership Experience
- Mentoring
- Public Speaking
- negotiation
- Supervising Experience
