Theoria Medical · 3 days ago

Director of Payor Credentialing

Novi, MI

Full-time

Remote

Director/Executive

$150K/yr - $150K/yr

10+ years exp

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Responsibilities

Team Building: Recruit, hire, and lead a credentialing team to manage all aspects of payer enrollment in-house.

Process Development: Establish credentialing workflows, policies, and procedures to streamline the enrollment process for providers, ensuring efficiency and compliance.

Payer Enrollment: Oversee and manage the payer enrollment process from start to finish, including application submission, CVO, CAQH management and provider communications.

Cross-Department Collaboration: Work closely with Revenue Cycle, HR, and Operations to ensure smooth onboarding and credentialing of new providers.

Revenue Cycle Support: Collaborate with the revenue cycle management team to resolve credentialing-related denials and streamline the reimbursement process.

Quality Control: Develop internal audit systems to ensure compliance with payer requirements and regulatory standards.

Reporting: Regularly report on credentialing metrics, including denial rates, enrollment timelines, and financial impact.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare credentialingPayer enrollmentLeadership experienceRevenue cycle managementTeam managementHealthcare administration degreeClearinghouse activity monitoringEDI processesEFT processesCredentialing workflowsGoogle DriveGoogle suiteExcelZoomMS Teams

Required

Bachelor's degree in healthcare administration or related field

Minimum of 10 years of experience in healthcare credentialing and payer enrollment, with at least 5 years in a leadership role managing a team.

Advanced knowledge of the healthcare industry and a strong financial background

Proven experience building and leading credentialing teams in a healthcare setting.

Experience in monitoring Clearinghouse activity, reports, and processes

Experience in setting up payors with EDI, ERA, and EFT processes

Knowledge and experience in startup of a new or established credentialing engagement

Experience in managing and leading a team of credentialing professionals

Strong analytical skills and attention to detail

Excellent communication and interpersonal skills

Ability to work in a fast-paced environment and manage multiple projects simultaneously

Agility, strong leadership, problem-solving skills

Working knowledge of Google Drive and Google suite of applications

Ability to maintain up-to-date knowledge of Technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS Teams

Must have a reliable internet connection