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
Related jobs
-
Provider Enrollment Representative USD 38K-62KBilling software | Credentialing | Electronic Claims | Epic | Microsoft OfficeMid-level Full TimeRemote SD (Central Time), United States R3d ago
-
Credentialing and Enrollment Specialist USD 58K-104KCAQH | Compliance | Credentialing | Data analytics | Database ManagementRemote workMid-level Full TimeLas Vegas, Nevada, UNITED STATES; REMOTE R4d ago
-
Credentialing and Enrollment Specialist USD 58K-104KCompliance | Credentialing | Data analytics | Database Management | Healthcare Data401k contribution | Career development opportunities | Comprehensive benefits package | Incentive and recognition programs | Inclusion-focused cultureMid-level Full TimeLas Vegas, Nevada, UNITED STATES; REMOTE R4d ago
-
Credentialing | Medicaid | Medicare | Provider enrollment | Re verificationMid-level Full TimeBILH Performance Network, United States R5d ago
-
IT HEDIS & Analytics Manager USD 82K-132KAPIs | Arcadia | Cotiviti | Data Quality | Data Warehouse401k employer match | Adoption reimbursement | Critical illness insurance | Dental insurance | Disability insuranceSenior-level Full TimeVirginia Remote, United States R5d ago
-
Strategist III, Value Analytics USD 127K-150KBenchmarking | Business Intelligence | Business case | Business case development | Case Development401k match | Employee coaching | Hands-on mentorship | Health benefits | Learning and development budgetSenior-level Full TimeUSA R6d ago
-
Credentialing | Data Management | Medicaid | Medicare | Provider enrollmentInfluenza vaccination required | Remote workMid-level Full TimeBILHPN - Wakefield, United States R7d ago
-
Manager HEDIS, Stars, & ACO Data Analytics #0714 USD 95K-120KACO | Audit Coordination | CMS | Data Integrity | Data integration401k employer match | CME Allowance | Commuter benefits | Dental insurance | Life insuranceMid-level Full TimeCA, CT, FL, GA, IL, IN, …10d ago
-
Senior Enrollment Specialist - Credentialing USD 68K-82KAdobe Acrobat | Data Integrity | Database Management | Document Generation | Medicaid401k match | Employee assistance program | Flexible spending account | Health savings account | LTD & STD insuranceSenior-level Full TimeRemote - Texas, United States R11d ago
-
Payer Rate Analytics Liaison USD 46K-56KAccountable Care | Accountable Care Organization | Commercial Insurance | Contracting | Data analytics401k match | Critical illness insurance | Dental insurance | Dependent care savings | Disability insuranceMid-level Full TimePhoenix, AZ, US12d ago
-
Provider Enrollment Specialist I USD 48K-68KCMS | Credentialing | Customer Service | Medicaid | MedicareCareer development | Childcare discount programs | Comprehensive health coverage | Employer paid medical/dental/vision | Free RTD EcoPassMid-level Full TimeAdministrative Offices, United States14d ago
-
Healthcare Enrollment Specialist USD 52K-64KBilingual (English/Spanish) | Bilingual English | CalFresh | Covered California | Customer ServiceEmployee discounts | Extended sick leave | FSA | Life insurance | Medical/Dental/Vision insuranceMid-level Full TimeHITEC Center - San Diego, CA, …16d ago
-
Healthcare Enrollment Specialist USD 52K-64KApplication Assistance | Bilingual (English/Spanish) | Bilingual English | CalFresh | Covered CaliforniaDental insurance | Employee discounts | Extended sick leave | FSA | Health insuranceMid-level Full TimeHITEC Center - San Diego, CA, …16d ago
-
Payor Enrollment Specialist Full Time USD 50K-55KAccount Receivable | Account Receivable Monitoring | CAQH | Credentialing | Directory managementEntry-level Full TimeColumbus, GA17d ago
-
Healthcare Enrollment Specialist USD 100KCalFresh | Covered California | Critical Thinking | Customer Service | Eligibility determinationCar provided for work travel | Employee discounts | Extended sick leave | FSA | Life insuranceMid-level Full TimeHITEC Center - San Diego, CA, …18d ago
-
88-50101857 Data Analytics Manager USD 186K-243KA/B | A/B Testing | B testing | Claims data | Claims data processingTelecommute up to 2 days per weekMid-level Full TimeSouth San Francisco, United States19d ago
-
Director, Pricing Implementation & Performance Analytics USD 232K-271K340B | Access Analytics | Chargebacks | Contract operations | ContractingExecutive-level Full TimeSSF, United States20d ago
-
Enrollment Specialist USD 42KAppointment Scheduling | Billing Compliance | Customer Service | Data confidentiality | Electronic Records401k matching | Dental insurance | Educational assistance | Employee discounts | Medical insuranceMid-level Full TimeFresno, CA, United States21d ago
-
Provider Enrollment Associate-Lead USD 38K-46KApogee | Claims Clearinghouse | Confidentiality | Credentialing | Customer ServiceSenior-level Full TimeRiedman Campus, United States21d ago
-
Manager, Credentialing & Provider Enrollment USD 81K-104KCredentialing | Database Management | Healthcare Audits | Healthcare Compliance | Healthcare trainingMid-level Full TimeHouston, TX, United States23d ago
-
CAQH | Critical Thinking | Cycle management | Managed care | Microsoft OfficeEntry-level Full TimeConover, NC, United States25d ago
-
Payor Enrollment Specialist USD 44K-52KCredentialing | Data entry | Microsoft Excel | Microsoft Teams | Microsoft WordMid-level Full TimeMidland, TX, United States25d ago
-
Provider Payer Enrollment Specialist - NWA USD 44K-52KCredentialing | Healthcare administration | Medical Staff | Medical Staff Services | Provider enrollmentDental insurance | Extended sick pay | Flex Time Off | Health insurance | Learning centerMid-level Full TimeFreeman Springdale Hospital, United States25d ago
-
Benchmarking | CPT | Claims Processing | Contract Negotiation | Contract languageHybrid work scheduleMid-level Full TimeAkron, OH25d ago
-
Provider Enrollment Specialist USD 113K-208KAgile | BRD | Business Analysis | CMS Regulations | ConfluenceHybrid work model | Professional development opportunities | Relocation support | Up to 10 percent travel | Up to 30 percent onsite workMid-level Full TimeGilbert, Arizona, United States; Lake Mary, …27d ago