Credentialing & Contracting Manager

This is a fully remote position, open to applicants in Sri Lanka.

📋 Description

• Oversee the entire credentialing process from the time an offer is accepted until the provider is ready and through ongoing maintenance.

• Manage and ensure that the third-party credentialing vendor meets established timelines, quality standards, service levels, and outcomes.

• Set credentialing priorities based on factors such as provider start dates, patient access, business expansion, geographic growth, and payer requirements.

• Conduct status reviews, identify obstacles and delays, and escalate any risks that may impact provider start dates or patient care.

• Supervise provider contracting, which encompasses employment agreements, independent contractor agreements, collaborative practice contracts, supervising physician arrangements, medical director roles, telehealth agreements, delegation, and related contracts.

• Ensure that provider contracts are finalized prior to the commencement of patient care and manage renewal and expiration timelines.

• Oversee the enrollment process for Medicare, Medicaid, and commercial payers, ensuring accurate enrollment reporting is maintained.

• Collaborate with Revenue Cycle and Billing teams to address any enrollment-related claims and reimbursement concerns.

• Take ownership of provider lifecycle management, which includes licenses, certifications, DEA registrations, malpractice coverage, collaborative agreements, practice locations, supervising physicians, and state expansions.

• Direct credentialing and contracting tasks related to provider offboarding, which involves payer notifications, contract terminations, and system updates.

• Maintain comprehensive, up-to-date, and audit-ready provider files.

• Develop key performance indicators (KPIs), dashboards, standard operating procedures (SOPs), and reporting mechanisms to provide leadership with visibility into credentialing performance.

• Identify avenues for automation, process enhancements, and standardization.

• Act as NIVA Health’s subject matter expert regarding provider credentialing operations.

• Collaborate with HR, Clinical Operations, Revenue Cycle, Billing, Finance, Compliance, Legal, and Executive Leadership.

⛳️ Requirements

• Minimum of 5 years of progressive experience in provider credentialing, payer enrollment, provider contracting, or healthcare operations.

• Comprehensive knowledge of Medicare, Medicaid, and commercial payer enrollment processes.

• Proven experience in provider credentialing and contracting, including collaborative practice agreements.

• Ability to manage multiple provider onboarding and credentialing projects simultaneously.

• Experience in managing or holding a third-party credentialing vendor accountable for their deliverables.

• Strong organizational capabilities and project management expertise.

• Advanced skills in Microsoft Excel and reporting.

• Familiarity with provider databases and credentialing software.

• Exceptional written and verbal communication abilities.

• A Bachelor's degree in Healthcare Administration, Business Administration, Human Resources, or a related field is preferred.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and continuing education.

• Flexible work schedule and remote work options.

• Generous paid time off and holiday leave.