Manager, Credentialing

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

📋 Description

• Exemplify and advocate for Aspirion's mission, vision, and core values.

• Provide guidance, direction, coaching, and support to Credentialing Specialists and Lead Credentialing Specialists.

• Supervise daily credentialing operations, encompassing initial credentialing, recredentialing, payer enrollment, provider demographic updates, and maintenance of provider records.

• Set and monitor team performance expectations regarding productivity, quality, accuracy, turnaround times, and service levels.

• Analyze operational reports and key performance indicators to detect trends, risks, and areas for improvement.

• Ensure that credentialing applications and documentation are thorough, accurate, and submitted punctually.

• Track provider credentialing and enrollment status while proactively identifying delays or obstacles.

• Address complex credentialing issues, payer discrepancies, and provider enrollment challenges.

• Collaborate with payers, providers, clients, and internal departments to investigate and resolve issues.

• Ensure that provider information and credentialing documentation are accurately and securely maintained.

• Oversee the verification of licenses, certifications, education, training, work history, sanctions, exclusions, malpractice coverage, and other necessary information.

• Guarantee compliance with payer requirements, regulatory standards, client expectations, company policies, HIPAA, NCQA standards, and relevant federal and state regulations.

• Collaborate with Operations, Client Success, Revenue Integrity, Quality, Compliance, and The People Team.

• Develop and execute process enhancements, automation, standardization, and workflow optimization.

• Lead the implementation of new credentialing processes, payer requirements, systems, and client initiatives.

• Conduct one-on-one meetings, team gatherings, coaching sessions, and performance evaluations.

• Assist in the recruitment, onboarding, training, and development of credentialing team members.

• Cultivate high-performing team members for future leadership positions.

• Collaborate with The People Team on employee relations, performance management, corrective actions, and employment-related issues.

• Maintain relationships with stakeholders and communicate credentialing status and escalations.

• Prepare and deliver operational reports and performance updates to senior leadership.

• Stay updated on credentialing regulations, payer requirements, healthcare standards, and regulatory changes.

• Engage in special projects and carry out additional duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is required.

• Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field is preferred.

• A minimum of three years of experience in credentialing, provider enrollment, healthcare operations, or a related field is required.

• A minimum of two years of supervisory or management experience is preferred.

• In-depth knowledge of provider credentialing, recredentialing, payer enrollment, and provider data management processes.

• Familiarity with healthcare payer requirements and credentialing standards.

• Experience in managing team performance and operational metrics.

• Strong analytical and problem-solving capabilities.

• Excellent written, verbal, and interpersonal communication skills.

• Proven ability to coach, mentor, and develop team members.

• Strong organizational and time management skills.

• Proficiency in Microsoft Office Suite, including Excel, Outlook, Word, Teams, and PowerPoint.

• Capacity to work efficiently in a fast-paced, deadline-oriented environment.

• Certification as a Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) is desired.

• Experience with CAQH, PECOS, NPPES, state licensing systems, and payer enrollment portals is preferred.

• Familiarity with credentialing software or provider data management systems is desired.

• Knowledge of NCQA, CMS, Medicare, Medicaid, and commercial payer credentialing requirements is preferred.

• Experience in managing credentialing for multiple clients, health systems, or provider groups is desired.

• Background in leading process improvement and workflow optimization initiatives is preferred.

• Experience managing remote or hybrid teams is desired.

• Documented success in enhancing credentialing turnaround times, quality, and operational efficiency is preferred.

• Experience in developing reports and analyzing credentialing performance metrics is desired.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Competitive salary and performance-based bonuses.

• Retirement savings plan with company match.

• Opportunities for professional development and career advancement.

• Flexible work arrangements.