Director of Credentialing
New
B
Behavioral Health WorksBehavioral Health
United StatesFull-TimeDirector
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of 7 years of experience in provider credentialing, healthcare compliance, provider enrollment, or payer contracting.
- Required Skills
- Salesforce
Requirements
- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field (Master's preferred).
- Minimum 7 years of experience in provider credentialing, healthcare compliance, provider enrollment, or payer contracting.
- Demonstrated experience with multi-state provider credentialing and payer enrollment operations.
- Experience within ABA, behavioral health, or healthcare services organizations.
- Proficiency with CAQH, NPPES, CMS I&A, Availity, Salesforce, and CentralReach.
- Strong knowledge of Medicaid, Medicare, and commercial payer credentialing requirements.
- Advanced proficiency in Microsoft Office Suite, specifically Excel.
- Strong leadership skills with experience managing team performance and development.
Responsibilities
- Oversee end-to-end provider credentialing and recredentialing operations across four companies in 10 states.
- Lead provider enrollment, revalidation, and maintenance activities with Medicaid, MCOs, Regional Centers, Medicare, and commercial payers.
- Ensure compliance with all federal, state, payer, and accreditation requirements.
- Conduct internal compliance audits and implement corrective action plans.
- Lead contracting initiatives and support payer negotiations.
- Manage the end-to-end policy lifecycle and organizational SOPs.
- Lead accreditation activities, including Autism Council on Quality (ACQ) standards.
- Lead, mentor, and develop credentialing, enrollment, and compliance team members.
View Full Description & ApplyYou'll be redirected to the employer's site
