Director of Credentialing & Payor Enrollment
Hoboken, NJ, United States
USD 130K-198K (estimate) Executive-level Full Time
Tasks
- Communicate credentialing status to stakeholders
- Conduct credentialing audits
- Coordinate managed care process improvements
- Develop credentialing policies and protocols
- Ensure compliance with accreditation and payer requirements
- Gather contract profile data
- Maintain payor matrix
- Manage payer credentialing for providers
- Monitor initial reappointment and expirable credentialing
- Monitor payor directories accuracy
- Perform contract monitoring and renewals
- Prepare credential files for medical staff committees
- Research and respond to inquiries
- Resolve escalated credentialing issues
- Review and analyze practitioner applications
- Review fee schedules for accuracy
- Review managed care processes for quality and efficiency
- Train staff on regulations and procedures
- Verify medical staff credentials
Perks/Benefits
- 401k retirement plan
- Dental insurance
- Employee wellness programs
- Health insurance
- Paid Holidays
- Paid time off
- Professional development
- Tuition reimbursement
- Vision insurance
Skills/Tech-stack
CMS Regulations | Contract Monitoring | Contract Renewals | Credentialing | Fee Schedule | Fee Schedule Review | Health Care Compliance | Health care | Healthcare Revenue | Healthcare revenue cycle | Joint Commission) | Managed care | NCQA | Payor Enrollment | Provider credentialing | Revenue Cycle | Schedule Review | URAC
Education
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