Director of Credentialing & Payor Development

Summary

Stable, growing company in the healthcare industry offering you the opportunity to advance your career in a fast paced environment with the support of an experienced leadership team.

We searching for an experienced Credentialing Director to oversee day-to-day operations of a remote team consisting of all elements of the credentialing processes. Selected individual should be able to develop and execute all credentialing and other provider onboarding functions in accordance with applicable department policies and procedures, payer and facility guidelines and regulatory rules. Candidate will work directly with senior leadership, employed and contracted medical staff and external clients to ensure department and company goals are achieved. Generates performance measures. Sets goals, and monitors performance against goals.

Responsibilities

• Ensure timely enrollment/re-enrollment into payer networks for employed and contracted medical staff
• Ensure timely facility credentialing for employed and contracted medical staff.
• Lead, develop and assess performance of a team of assigned associates.
• Communicate effectively across all levels of the company.
• Provide performance reports to key stakeholders.
• Work collaboratively and effectively as the credentialing liaison to multiple departments simultaneously.
• Act as a liaison between the company and third party payers.
• Collaborate with billing and operations teams to ensure contracted payer claims are processed accurately.
• Evaluate the adequacy and effectiveness of internal controls.
• Develop recommendations for corrective action and process improvement.
• Prepare formal work product summarizing audit outcomes for departmental review.
• Report variances to standards of practice and compliance.
• Provider oversight relative to facility and third-party payer credentialing/re-credentialing for internal / external processes.
• Clearly and effectively communicate with providers, Operations team and insurance companies handling all questions dealing with day-to-day operation of credentialing and enrollments.
• Knowledge of provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards for multiple states.

Skills & Qualifications

• Bachelor's Degree from four-year college or university required, and 2-4 years of management/leadership experience is preferred; or equivalent combination of education and experience.
• Demonstrated knowledge of facility and/or payer credentialing a definite plus but, not required.
• Ability to manage and direct both onsite and remote employees and ensure internal controls are followed is essential.
• Highly analytical with the ability to demonstrate command of the details and to articulate those details is essential.
• Strong interpersonal skills with an ability to work effectively in a team environment.
• Very strong written and oral communication skills.
• Ability to effectively prioritize and execute tasks in a high-pressure environment.
• Strong interpersonal, project management and mentoring skills.
• Understanding of billing, coding, and denial processes as they pertain to credentialing.

Certificates and Licenses:

• Certified Provider Credentialing Specialist or willing to obtain.

Supervisory Responsibilities:

• Will supervise a team of payer and prover credentialing specialists.

If you are ready to join an exciting, progressive company and have