- Lead all front-end operations, including registration, benefits verification, medical documentation, and prior authorization.
- Own credentialing systems, vendors, and tools including CAQH, NPPES, payer portals, and internal platforms.
- Analyze root causes of rejections and edits to implement corrective actions and minimize denials.
- Own payer enrollment and credentialing activities and coordinate payer contracting submission.
- Oversee the review and validation of practitioner applications.
- Monitor key performance indicators (KPIs) such as clean claim rates, insurance verification accuracy, and charge lag.
- Provide regular executive-level updates on credentialing performance, priorities, and operational risks.
- Hire, train, and manage staff productivity, providing coaching to ensure compliance with HIPAA and payer policies.
- Lead, coach, and develop the Credentialing & Licensing team.
- Collaborate with clinical, back-end RCM, and billing teams to improve cash flow and revenue acceleration.
- Partner closely with Provider Onboarding and Growth teams to ensure all required documentation is collected promptly and credentialing is initiated without delay.
- Develop SOPs and implement new IT systems to improve process efficiency.
- Design and implement scalable credentialing and enrollment workflows.
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