Job Description
Job Summary:
We are seeking an experienced and detail-oriented Credentialing Team Lead with multistate experience to oversee and manage the credentialing process for our healthcare providers. The ideal candidate will have a strong background in credentialing, including handling licensing, privileging, and compliance across multiple states. This role involves leading a team, ensuring timely and accurate credentialing, and maintaining compliance with state and federal regulations.
Key Responsibilities:
Team Leadership and Oversight
Lead and manage the credentialing team, providing training, support, and performance feedback.
Develop and implement best practices to improve efficiency and accuracy in credentialing processes.
Monitor team performance and ensure timely completion of credentialing and re-credentialing tasks.
Credentialing and Compliance
Oversee the end-to-end credentialing and privileging process for providers across multiple states.
Ensure all provider files are complete and compliant with state, federal, and payer-specific requirements.
Maintain accurate and up-to-date records in the credentialing database.
Manage the submission and tracking of applications for licensure, DEA registration, and insurance paneling.
Multistate Credentialing Management
Manage the complexities of multistate licensing and credentialing requirements.
Stay updated on changes in state regulations and payer requirements.
Resolve credentialing issues or discrepancies across different states.
Communication and Coordination
Act as the primary point of contact between providers, payers, and internal departments regarding credentialing matters.
Provide regular updates to leadership on credentialing status and any challenges.
Work closely with legal, compliance, and human resources teams to align credentialing processes with company policies.
Process Improvement and Reporting
Identify opportunities to streamline credentialing processes and improve turnaround time.
Generate and analyze reports to monitor credentialing performance and identify areas for improvement.
Ensure all credentialing deadlines are met to avoid disruptions in provider services.
Requirements & Skills
- Strong understanding of the credentialing process and medical regulations.
- Excellent organizational and leadership skills.
- Proficient in using credentialing software and database management systems.
- Exceptional communication and interpersonal skills to effectively work with team members and clients.
Benefits & Perks
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