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Theoria Medical · 7 hours ago

Full-time Payer Credentialing Manager - Remote (US)

United States

Full-time

Remote

Mid, Senior Level

3+ years exp

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum. They are seeking a Payer Credentialing Manager to lead payer credentialing and re-credentialing processes for healthcare providers while ensuring compliance with accreditation standards and regulatory requirements.

Electronic Health Record (EHR)Health CareHome Health CareHospital

Responsibilities

Oversee the processing of initial payer applications for health professionals, ensuring compliance with national accreditation standards and state/federal regulations

Maintain and manage payer credentialing databases and electronic records, ensuring accuracy, confidentiality, and audit readiness

Liaison with medical staff leadership, payers, licensure boards, and regulatory agencies to resolve credentialing issues promptly

Supervise payer credentialing staff by coordinating workloads, providing training, monitoring performance, and ensuring quality outcomes

Conduct regular audits of payer credentialing processes to identify gaps, implement corrective actions, and drive continuous improvement

Qualification

Payer credentialing systemsPayer enrollment processesHealthcare administrationDatabase managementMicrosoft OfficeRegulatory guidelinesOrganizational skillsAttention to detailCommunication skillsProblem-solving skills