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American Family Care · 1 month ago

Future Opening: Director of Credentialing

United States

Full-time

Remote

Director/Executive

$115K/yr - $130K/yr

7+ years exp

American Family Care (AFC) is one of the largest urgent care networks in the U.S. providing services seven days a week. The Director of Credentialing is responsible for leading and managing the organization's credentialing, privileging, and provider enrollment operations, ensuring compliance with regulatory standards and enhancing operational excellence.

Health CarePrimary and Urgent Care

Responsibilities

Provide strategic leadership for all credentialing, recredentialing, privileging, and provider enrollment activities

Build, lead, and mentor a high-performing credentialing team with appropriate staffing, training, accountability, and performance management

Develop and implement departmental goals, SOPs, KPIs, and quality assurance measures

Facilitate training, ongoing education, and change management as credentialing systems and requirements evolve

Oversee verification of licensure, education, training, certifications, work history, malpractice coverage, and professional references

Establish proactive workflows for managing all expirable items, including license, certification, and insurance renewals

Ensure accurate management of provider files, credentialing data, and documentation within credentialing software platforms

Direct the privileging process in collaboration with medical leadership, department chiefs, and compliance teams

Provide credentialing support for committee meetings, audits, board reviews, and documentation needs

Ensure compliance with all federal, state, and local regulatory bodies including CMS, The Joint Commission, NCQA, URAC, and commercial payer standards

Maintain up-to-date knowledge of regulatory changes and lead revisions to policies, procedures, and workflows accordingly

Conduct and oversee internal audits to ensure readiness for accreditation surveys and external reviews

Oversee timely and accurate submission of enrollment applications with Medicare, Medicaid, and commercial payers

Track and manage enrollments, revalidations, payer updates, and expirables to prevent reimbursement delays or claim denials

Partner with Revenue Cycle and Managed Care to resolve enrollment-related claim issues and streamline payer setup workflows

Manage external credentialing and verification vendors, ensuring high performance, compliance, service quality, and contractual adherence

Evaluate vendor capabilities, negotiate service agreements, monitor KPIs, and drive accountability for accuracy and turnaround times

Lead transitions, implementations, or optimization projects involving outsourced credentialing or enrollment partners

Continuously evaluate and enhance credentialing workflows to reduce turnaround times, improve accuracy, and support scalability

Lead implementation or optimization of credentialing software, automation tools, and data-management technologies

Develop and oversee dashboard reporting for KPIs, productivity, turnaround time, expirables, enrollment status, and quality metrics

Collaborate with IT, Managed Care, Compliance, and Operations on cross-functional systems and technology initiatives

Serve as the primary organizational contact for providers, clinical leaders, health plans, and regulatory bodies regarding credentialing matters

Promote a provider-centric experience through timely communication, streamlined processes, and exceptional service standards

Collaborate with HR, Legal, Compliance, Managed Care, and Clinical Operations on onboarding and cross-functional initiatives

Deliver clear, concise presentations to executive leadership, including reporting on credentialing performance, risks, and mitigation strategies

Prepare and present executive-ready materials including slide decks, dashboards, and credentialing summaries for operational and leadership reviews

Qualification

Credentialing experienceCMS regulationsCredentialing software proficiencyLeadership experienceMaster's degreeCPCS certificationProject management abilitiesAnalytical skillsRelationship managementAttention to detailOrganizational skillsCommunication skills