Full Time Director, Existing Credentialing - Remote (US)
Skills
- Deep expertise in healthcare provider credentialing and payer enrollment requirements.
- Strong leadership and team management skills in a high-volume credentialing environment.
- Knowledge of federal and state healthcare regulations and accreditation standards.
- Experience with credentialing software platforms such as Modio, CAQH, or Verity.
- Excellent communication, project management, and problem-solving abilities.
- Ability to work effectively in a fast-paced, remote, multi-stakeholder environment.
Responsibilities
- Lead full-cycle credentialing for all new healthcare providers ensuring timely and accurate completion.
- Manage a credentialing team including coordinators and specialists to meet onboarding goals.
- Oversee document collection, primary verifications, background checks, and payer enrollment applications.
- Ensure compliance with federal, state, and payer regulations including Medicare, Medicaid, NCQA, and URAC.
- Collaborate with Talent Acquisition, Legal, HR, and Clinical Leadership to streamline onboarding.
- Develop and maintain credentialing policies, procedures, and SOPs aligned with industry best practices.
- Track and report credentialing KPIs, identify bottlenecks, and implement process improvements.
- Stay updated on industry standards, regulatory changes, and credentialing technology tools.
- Support audits and accreditation processes as needed.
- Partner with IT and Operations to ensure data integrity and automation.
Education
- Bachelor’s degree required.
- Advanced degree in healthcare administration, public health, or related field preferred.
Benefits
- Competitive salary and benefits package.
- Opportunity to impact a growing, mission-driven healthcare organization.
- Supportive, collaborative, and fast-moving work environment.
- Remote work flexibility.
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Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitu...
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