Director of Payer Credentialing and Enrollment

About Our Company 

CardioOne partners with independent cardiologists to provide innovative solutions that improve patient outcomes and reduce costs. Our value-based cardiology care solutions help our physician partners thrive in the shift to value-based care. CardioOne offers a magnificent work environment, good working conditions, and competitive pay. We offer medical, dental, vision, and a 401k plan with a match to benefit eligible employees. We offer PTO (Personal Time Off) and sick time to full-time employees.  We take pride in creating a culture of employee engagement that translates into an exemplary patient experience. Join us in our mission to positively impact US cardiology.  

About the Role 

The Director of Payor Credentialing and Enrollment will be responsible for daily operations for credentialing and will ensure all providers are appropriately credentialed with independent cardiology practices and health plans. This role's objectives are to meet or exceed required turnaround times, quality goals, and productivity goals, and to ensure consistency across staff performance in credentialing. In addition, this person will manage provider enrollment, managing the relationship with our external partner that works directly with payers to enroll our providers. You will work remotely and report to the VP of Revenue Cycle Management.

What you’ll do: 

• Develop and execute a strategic plan for payer enrollment, ensuring timely and accurate enrollment in all relevant healthcare networks. 
• Coordinate with various departments to gather necessary documentation and information for enrollment applications. 
• Stay updated on changes in payer requirements and regulations to ensure ongoing compliance. 
• Oversee the credentialing process for healthcare providers within the organization, ensuring compliance with industry standards and accrediting bodies. 
• Manage the preparation and submission of credentialing applications to payers, ensuring accuracy and completeness. 
• Collaborate with medical staff offices to maintain provider credentialing files and ensure timely renewals. 
• Build and maintain positive relationships with payer representatives to facilitate smooth enrollment and credentialing processes. 
• Act as the primary point of contact for payer inquiries and issue resolution related to enrollment and credentialing matters. 
• Develop and implement policies and procedures related to payer enrollment and credentialing processes. 
• Ensure that organizational policies align with industry best practices and regulatory requirements. 
• Oversee the maintenance of accurate and up-to-date provider information in relevant databases and systems. 
• Implement data quality control measures to ensure the integrity of provider information. 
• Monitor and enforce compliance with payer requirements and accreditation standards. 
• Prepare for and participate in audits related to payer enrollment and credentialing. 
• Develop and track key performance indicators (KPIs) to assess the efficiency and effectiveness of the payer enrollment and credentialing processes. 
• Implement continuous improvement initiatives based on performance metrics. 
• Maintain knowledge base of appropriate national accrediting agencies such as AMA, CMS, and The Joint Commission 

What you’ll need:  

• Bachelor’s degree in Business or a related field 
• 7-10 years’ experience in the healthcare industry working in the payor segment with experience working directly or indirectly with provider credentialing or enrollment  
• Solid understanding of federal and state regulations related to credentialing and provider enrollment, including experience with and knowledge of CAQH and credentialing processes  
• Knowledge of delegated credentialing and verification  

Who you are: 

• Communicates Effectively. You are effective in a variety of communication settings: one-on-one, small and large groups, or among diverse styles and position levels. 
• Optimizes Work Processes. You are aware of the most effective and efficient processes to get things done and are focused on continuous improvement. 
• Drives Results. You persist in accomplishing objectives and exceeding goals despite obstacles and setbacks, while also helping others to achieve results. 

You will work out of one of the following locations:  

• Remote: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming  

Additional Information:

Full time base salary of $100,000 to $120,000 plus medical, dental, and vision benefits. 

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