Credentialing Manager

6+ years of progressive experience in healthcare credentialing, with a significant portion dedicated to managing delegated functions Deep, demonstrated experience supporting and managing delegated credentialing agreements Deep understanding and practical experience with NCQA standards Strong working knowledge of the Revenue Cycle Management process and regulatory nuances specific to mental/behavioral health services Proven experience establishing, monitoring, and reporting compliance KPIs and scorecards Exceptional organizational and project management skills Proven ability to interpret complex regulatory language (NCQA, CMS, etc.) and translate it into operational workflows 6+ years of progressive experience in healthcare credentialing, with a focus on managing delegated functions

Serve as subject matter expert for payer audits related to delegated credentialing Implement and maintain NCQA standards for credentialing policies Design and maintain Compliance Scorecard and KPIs for credentialing and RCM Ensure organization is prepared for annual audits Monitor and update policies based on changes in payer, state, and federal laws Lead compliance efforts within the RCM division Identify and eliminate bottlenecks in Credentialing and RCM workflows Oversee performance of CVO and internal support partners Ensure annual required trainings are completed for RCM and Credentialing staff Facilitate and support the Credentialing Committee Act as a hands-on individual contributor when necessary