AVP Provider Enrollment Credentialing
Peak Health Administrative Building, United States
USD 120K-135K (estimate) Executive-level Full Time
Tasks
- Coordinate with payer relations revenue cycle and finance
- Develop provider credentialing strategy
- Drive workflow automation for scalability and accuracy
- Ensure HIPAA False Claims Act and Anti-Kickback compliance
- Ensure NCQA Joint Commission and CMS compliance
- Escalate PHO credentialing and enrollment discrepancies
- Execute payer enrollment strategy
- Lead provider credentialing and privileging operations
- Maintain NPI and PECOS data
- Maintain delegated credentialing agreements
- Maintain provider CAQH attestation
- Manage PHO credentialing and payer enrollment operations
- Manage payer enrollment operations for Medicare Medicaid and commercial
- Manage provider roster updates
- Manage vendor relations and service level agreements
- Monitor enrollment turnaround time to reduce revenue leakage
- Oversee medical staff credentialing and reappointment
- Partner with physician recruitment to streamline onboarding
- Prepare for accreditation surveys
Perks/Benefits
- N/A
Skills/Tech-stack
Accounts Receivable | Accreditation Survey Readiness | Anti Kickback | Anti Kickback Statute | CAQH | CMS | Clean Claim | CredentialStream | Credentialing | Days in Accounts Receivable | Delegated Credentialing | False Claims Act | HIPAA | Joint Commission) | NCQA | NPPES) | PECOS | PHO Governance | Payer enrollment | Primary Source Verification | Revenue Cycle | Source verification | Survey Readiness | Turnaround Time | Workflow automation
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