Vice President of Credentialing & Regulatory Compliance

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Requirements:

• Bachelor’s or Master’s degree in Human Resources, Business Administration, or a related field.
• Minimum of 10 years of credentialing experience, including leadership in a healthcare setting.
• Strong expertise in compliance, provider enrollment, and onboarding processes.
• Ability to create and enforce credentialing policies while ensuring alignment across departments.
• Strong leadership, communication, and problem-solving skills.
• High attention to detail and the ability to manage multiple priorities effectively.

Responsibilities:

• Oversee the entire credentialing function, ensuring all provider enrollments, renewals, and state expansions are completed accurately and on time.
• Ensure compliance with all regulatory and accreditation requirements for internal providers and external partners.
• Develop and enforce credentialing policies and procedures aligned with federal, state, and payer regulations.
• Lead and manage the onboarding credentialing process for new providers, ensuring they are fully credentialed before their start date.
• Manage ongoing provider credentialing, including COI (Certificates of Insurance), DEA registration, license renewals, recredentialing.
• Oversee credentialing for new state launches to ensure smooth expansion into new markets.
• Continuously improve credentialing systems and processes, leveraging automation and technology to enhance efficiency.
• Serve as the primary liaison between Human Resources, Legal, Compliance, and Clinical teams to align credentialing efforts.
• Maintain strong relationships with external payors and credentialing partners to ensure compliance with all requirements.