POSITION SUMMARY:
The Director of Payer and Credentialing is a key corporate functional role for the organization, that administers credentialing and provider enrollment services. This role is responsible for managing and monitoring processes and procedures that support credentialing, re-credentialing, expirable data management, and ensuring compliance with state and federal regulations. Reporting directly to the CEO, this position is instrumental in upholding credentialing compliance to ensure the company’s success.
ESSENTIAL FUNCTIONS:
Strategic Leadership
- Analyze and implement process improvements to enhance efficiency of credentialing.
- Serve as a primary resource to employees with regards to issues, interpretation and application and department police and procedures.
- Conducts periodic audits of credentialing files and staff work product.
Operational Excellence
- Coordinates with practice management, licensing agencies, insurance carriers to complete credentialing and re-credentialing applications.
- Develop and implement department controls and procedures to ensure accuracy and efficiency.
- Ensure compliance with the credentialing requirements of the health plan partners, and related regulatory and accrediting agency requirements.
Collaboration and Reporting
- Collaborate with leadership on policy development and standardization of criteria/processes across the organization.
- Monitors external credential databases to ensure data is updated and ready for quick retrieval and use by interested parties.
- Oversee processes and reviews all reports related to adverse actions such as sanctions, licensure actions or limitations, and credentialing-related complaints.
Compliance
- Ensure compliance with state and federal regulations related to delivery and documentation of patient care.
- Monitor renewals of licensure and other documents subject to expiration, and ensures updates are forwarded to facilities and healthcare partners as renewals are received.
- Develops and provides regular reports and presentations concerning the operation and progress of the credentialing functions, including activity related to approvals, denials and/or appeals.
Team Development
- Direct the output of a team of employees and provide ongoing training as needed regarding new guidelines or updated processes/policies.
- Foster a positive and collaborative work environment, promoting teamwork and cross-functional cooperation.
KNOWLEDGE, SKILLS & ABILITIES
- Excellent communication skills (written and verbal), as well as exceptional people skills.
- Exceptional leadership abilities with a problem-solving mindset and a focus on team engagement and transparency.
- Strong understanding and use of web-based credentialing applications.
- Ability to manage multiple priorities in a fast-paced environment while working professionally, courteously, collaboratively, and cooperatively in a team environment.
- Ability to build partnerships with management, staff, and stakeholders to achieve department and organizational goals and objectives.
- Attention to detail and ability to analyze large amounts of data.
- Proficient with Microsoft Office Suite, database administration and scanning applications.
EDUCATION & EXPERIENCE
- Minimum of 7 years in a credentialing experience with at least 2 years in a supervisory role.
- Bachelor's degree in business administration or healthcare related field.
- Master's degree and/or relevant field preferred.
- Database management skills including querying, reporting, and document generation.
SUPERVISORY RESPONSIBILITIES
Manage the Credentialing department and its associates.
WORKING CONDITIONS
General office working conditions.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.
While performing the duties of this job, the associate will be required to stand, walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The associate must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust.
to focus. Frequent travel is required, often up to several hours of driving per day. Ability to travel to, attend, and conduct sales presentations. Manual dexterity is required to use desktop computers and peripherals. Exposure to variable weather conditions is likely.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those that must be met by an associate to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
TRAVEL
Travel is primarily local during the business day, although some out-of-area and overnight travel may be expected as the company grows into other regions.
SAFETY HAZARD OF THE JOB
Minimal Hazards
Job Type: Full-time
Pay: Up to $90,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Experience:
- Microsoft Office: 1 year (Preferred)
- Microsoft Word: 1 year (Preferred)
Work Location: Remote