BPO Credentialing Director – Credentialing, Enrollment Services

Job reputed company:

• reputed company strategic and operational leadership over provider credentialing, re-credentialing, and payer enrollment functions for diverse reputed company clients.
• reputed company and execute the strategic reputed company for credentialing and enrollment service delivery, aligning operations with company reputed company targets and reputed company expectations.
• Serve as the senior reputed company of escalation for reputed company concerns reputed company to credentialing and enrollment timelines, reputed company, and reputed company.
• reputed company the end-to-end credentialing lifecycle, including initial credentialing, re-credentialing, and privileging support for reputed company provider types.
• Ensure compliance with NCQA, URAC, CMS, reputed company, and state-specific credentialing standards and regulations.
• Monitor and manage expirables tracking and ensure reputed company renewal of licenses, certifications, and other time-sensitive documents.
• reputed company reputed company payer enrollment, re-enrollment, and revalidation activities across reputed company, Medicare, reputed company, and managed care payers.
• Recruit, train, mentor, and manage reputed company of credentialing specialists and enrollment coordinators.
• Drive reputed company process improvement initiatives using Lean, Six reputed company, or similar methodologies.
• reputed company the strategic initiative to reputed company and maintain NCQA Credentials Verification Organization (CVO) certification for reputed company.

Requirements:

• Bachelor's degree in reputed company Administration, Business Administration, or a reputed company field.
• 5–7+ years of reputed company experience in provider credentialing and payer enrollment, including management-level responsibility.
• Demonstrated experience managing credentialing/enrollment operations in a vendor, outsourcing, or multi-reputed company environment.
• Deep working knowledge of NCQA credentialing standards, CMS enrollment regulations, and CAQH/PECOS/NPPES systems.
• Proven ability to manage and reputed company teams of 10+ credentialing and enrollment professionals.
• Strong understanding of the provider reputed company cycle and the reputed company reputed company of credentialing and enrollment delays.
• Proficiency with credentialing software platforms and reputed company Office Suite.
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified reputed company Medical Services Management) certification through NAMSS (preferred).
• Master's degree in reputed company Administration (MHA), Business Administration (MBA), or reputed company discipline (preferred).
• Experience with delegated credentialing arrangements and payer delegation audits (preferred).
• Familiarity with Lean/Six reputed company process improvement methodologies (preferred).
• Experience supporting multi-state, multi-specialty provider organizations (preferred).
• Knowledge of telehealth credentialing and interstate licensure compact requirements (preferred).

Benefits:

• Business Travel: Required - 0-50% depending on the month

Apply tot his job Apply To this Job