Credentialing Manager

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    "requisitionDescription": "<div><div><p id=\"isPasted\">At Infusion for Health, we are dedicated to providing exceptional care to our patients! We believe in delivering high-quality healthcare services with compassion and empathy. As we continue to grow, we are seeking a dynamic and experienced Credentialing Manager to join our team. This is a newly created role designed to help us continue to grow and scale our organization and credentialing efforts.</p><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;' data-pasted=\"true\"><span style='font-family:\"Times New Roman\",serif;'>The Credentialing Manager oversees all aspects of provider and organizational credentialing, recredentialing, privileging, and payer enrollment. This includes ensuring compliance with <strong>CMS, The Joint Commission (TJC), NCQA, URAC, and state/federal regulations</strong> while maintaining accurate provider and facility credentialing records. The role also leads credentialing for new site/location expansion, ensuring timely payer enrollment to support revenue cycle operations.</span></p><p style=\"margin-left:0in;\" data-pasted=\"true\"><strong>Credentialing</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Manage the end-to-end credentialing process for physicians, advanced practice providers, and allied health professionals.</li><li style=\"margin-left:0in;\">Oversee initial credentialing, recredentialing, and continuous monitoring of licensure, DEA registration, board certification, malpractice coverage, and sanction/exclusion lists.</li><li style=\"margin-left:0in;\">Ensure compliance with <strong>CMS, TJC, NCQA, URAC, and payer enrollment standards</strong>.</li><li style=\"margin-left:0in;\">Maintain credentialing database(s) and provider/facility files with accurate, real-time information.</li></ul><p style=\"margin-left:0in;\"><strong>New Site/Location Credentialing</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Lead credentialing and payer enrollment activities for new sites, clinics, and facilities.</li><li style=\"margin-left:0in;\">Coordinate with operations, finance, and revenue cycle teams to ensure new locations are:<ol start=\"1\" type=\"1\"><li>Properly registered with Medicare, Medicaid, and commercial payers.</li><li>Credentialed under organizational NPI and Tax ID as applicable.</li><li>Fully operational for billing and reimbursement by the go-live date.</li></ol></li><li style=\"margin-left:0in;\">Serve as liaison with payers to resolve credentialing or site enrollment delays that impact reimbursement.</li></ul><p style=\"margin-left:0in;\"><strong>Leadership &amp; Team Oversight</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Supervise credentialing staff, providing training, guidance, and performance management.</li><li style=\"margin-left:0in;\">Develop, implement, and update credentialing policies, workflows, and SOPs.</li><li style=\"margin-left:0in;\">Act as a resource for medical staff, operations, and compliance leadership.</li></ul><p style=\"margin-left:0in;\"><strong>Compliance &amp; Audit Preparedness</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Monitor regulatory and payer requirements; implement changes to maintain compliance.</li><li style=\"margin-left:0in;\">Conduct internal audits of credentialing and enrollment files, ensuring accuracy and timeliness.</li><li style=\"margin-left:0in;\">Partner with Compliance and Legal to mitigate risk related to provider or facility credentialing.</li></ul><p style=\"margin-left:0in;\"><strong>Revenue Cycle / Payer Enrollment</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Oversee and track payer enrollment for providers and locations to minimize claim denials and payment delays.</li><li style=\"margin-left:0in;\">Manage payer portal access, create and manage user logins, setup administration.</li><li style=\"margin-left:0in;\">Collaborate with billing and contracting to maintain alignment between payer rosters and credentialing data.</li><li style=\"margin-left:0in;\">Ensure timely updates to CAQH, PECOS, and payer portals.</li></ul><p style=\"margin-left:0in;\" data-pasted=\"true\"><strong>Qualifications</strong></p><p style=\"margin-left:0in;\"><strong>Education &amp; Experience</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Bachelor&rsquo;s degree in Healthcare Administration, Business, or related field required (Master&rsquo;s preferred) or equivalent experience.</li><li style=\"margin-left:0in;\">Minimum 5 years of provider/facility credentialing experience, with 2+ years leadership responsibility.</li><li style=\"margin-left:0in;\">Direct experience with new location/site credentialing and payer enrollment.</li><li style=\"margin-left:0in;\">Familiarity with credentialing software and payer systems (CAQH, PECOS).</li></ul><p style=\"margin-left:0in;\"><strong>Certifications</strong></p><ul type=\"disc\"><li style=\"margin-left:0in;\">Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.</li></ul><p>&nbsp;</p></div></div>\n<br/>Monday to Friday",
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