Credentialing Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and manage the complete credentialing life cycle, which includes initial credentialing, recredentialing, and tracking expiration dates.

• Supervise payer enrollment applications, maintain PECOS updates, manage CAQH records, NPPES documentation, and oversee delegated agreements.

• Ensure adherence to NCQA, CMS, and commercial payer standards.

• Keep an accurate and up-to-date credentialing database.

• Lead, mentor, and guide Provider Enrollment Specialists.

• Ensure prompt submission of applications and follow-up actions.

• Develop, document, and enhance credentialing workflows, standard operating procedures (SOPs), and key performance indicators (KPIs).

• Serve as the primary point of contact with insurance plans to address enrollment delays or challenges.

• Stay informed about payer policy changes and state/federal regulations.

• Assist in credentialing-file audits.

• Provide weekly and monthly updates regarding credentialing status and turnaround timelines.

• Monitor and report on pending expirations to prevent lapses.

• Prepare credentialing rosters and summaries of enrollment.

• Advocate for the company’s culture and dedication to patient care.

• Align strategic objectives and resources to enhance profitability.

• Collaborate with various departments to identify needs and create scalable solutions.

• Participate in integration and post-acquisition teams as required.

• Drive operational excellence to meet financial targets.

• Build and lead collaborative teams, nurture talent, and connect performance with business goals.

• Guide and assess the work of other team members.

• Recruit, onboard, train, inspire, and retain current and future leaders.

• Carry out other assigned responsibilities.

⛳️ Requirements

• A bachelor’s degree or equivalent experience is required.

• 3-5 years of experience in credentialing is necessary.

• At least 2 years in a supervisory capacity is preferred.

• Experience in optometry/ophthalmology or outpatient healthcare is a plus.

• Familiarity with delegated credentialing and/or managed care contracting is preferred.

• CPCS or CPMSM certification is advantageous.

• Proficient in Strategic Relationship Management.

• Possess advanced communication skills.

• Skilled in influence and negotiation.

• Experience in cross-functional collaboration.

• Capable of process improvement and problem-solving.

• Strong project and time management abilities.

• Proficient in Microsoft Office applications.

• In-depth knowledge of CPT, ICD-10, and HCPCS codes pertinent to optometry/ophthalmology.

• Understanding of insurance guidelines relevant to optometry/ophthalmology.

• Meticulous attention to detail.

• Demonstrated professional integrity.

• Effective communication skills, both verbal and written.

• Ability to comprehend spoken information both in-person and electronically.

• Adequate visual acuity to ensure accuracy in work performed on screens and in documents.

• Capacity to maintain focus and attention to detail over extended periods.

🏝️ Benefits

• This is a remote position.

• Reasonable accommodations may be provided to qualified individuals with disabilities in accordance with applicable laws.