Credentialing Manager

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

📋 Description

• Supervise all facets of payer enrollment, recredentialing, and the continuous management of provider participation within insurance networks.

• Direct the complete credentialing lifecycle, which encompasses initial credentialing, recredentialing, and tracking expiration dates.

• Oversee the completion of payer enrollment applications, updates to PECOS, maintenance of CAQH, NPPES records, and management of delegated agreements.

• Ensure adherence to compliance standards set by NCQA, CMS, and commercial payers.

• Maintain a precise credentialing database.

• Lead, oversee, and provide support to Provider Enrollment Specialists.

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

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

• Keep track of payer policy changes and state/federal regulations.

• Assist with credentialing-file audits.

• Deliver weekly and monthly updates regarding credentialing status and turnaround times.

• Monitor and report on pending expirations to prevent lapses.

• Prepare credentialing rosters and enrollment summaries.

• Promote company culture and a commitment to quality patient care.

• Align strategic objectives and resources to enhance profitability.

• Collaborate across the organization to create scalable solutions.

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

• Foster operational excellence and ensure compliance.

• Recruit, hire, train, motivate, retain, guide, and assess employees.

⛳️ Requirements

• A Bachelor’s degree or equivalent experience is mandatory.

• 3-5 years of experience in credentialing.

• 2+ years in a supervisory capacity.

• Preference for experience in optometry/ophthalmology or outpatient healthcare.

• Experience in delegated credentialing and/or managed care contracting is preferred.

• CPCS or CPMSM certification is a plus.

• Familiarity with NCQA, CMS, and commercial payer standards.

• Proficiency in Microsoft Office applications.

• Strong understanding of CPT, ICD-10, and HCPCS codes pertinent to optometry/ophthalmology.

• Knowledge of insurance guidelines relevant to optometry/ophthalmology.

• Capable of strategic relationship management.

• Excellent communication skills.

• Skills in influence and negotiation.

• Ability to collaborate cross-functionally.

• Experience in process improvement and problem-solving.

• Strong project and time management abilities.

• Detail-oriented with a commitment to professional integrity.

• Ability to communicate effectively through both verbal and written channels.

• Must be able to hear and comprehend spoken information in-person and through electronic means.

• Visual acuity necessary to ensure accuracy in work involving screens and documents.

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

🏝️ Benefits

• Position allows for remote work.

• Reasonable accommodations may be provided to qualified individuals with disabilities.

• Work environment includes a professional office and/or remote office setting.

• We are an Equal Opportunity Employer.