Manager, Credentialing

🕒 Agosto 25

🎰 Nevada – Remoto

🎰 Nevada – Remote

💵 $70.000 - $85.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 0%

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Aspirion

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2006

💼 Consultoria

📦 Logística

🛡️ Seguros

💰 Series unknown em 2012-02

Consulting • Logistics • Insurance

Aspirion é uma empresa de gestão de ciclo de receita na área da saúde que auxilia hospitais a recuperar receitas de reivindicações negadas e complexas. A empresa emprega automação por IA e uma plataforma proprietária chamada Compass, composta por advogados, clínicos e engenheiros de IA, todos baseados nos EUA, para reverter negações clínicas, maximizar reembolsos fora da rede, realizar revisões de saldo zero e recuperar variações de pagamento em serviços como gestão de negações, gestão de contas a receber (AR), reivindicações complexas, acidentes de trânsito, compensação de trabalhadores, TRICARE e Medicaid de fora do estado. A Aspirion enfatiza o impacto mensurável de recuperação (mais de $6 bilhões capturados), aumento de coleções para os clientes, certificação HITRUST, prêmios Best in KLAS e parcerias com grandes sistemas de saúde.

Descrição

• Demonstrate and promote Aspirion's mission, vision, and core values • Provide leadership, direction, coaching, and support to Credentialing Specialists and Lead Credentialing Specialists • Oversee daily credentialing operations, including initial credentialing, recredentialing, payer enrollment, provider demographic updates, and maintenance of provider records • Establish and monitor team performance expectations for productivity, quality, accuracy, turnaround times, and service levels • Review operational reports and key performance indicators to identify trends, risks, and improvement opportunities • Ensure credentialing applications and documentation are complete, accurate, and submitted on time • Monitor provider credentialing and enrollment status and proactively identify delays or barriers • Resolve complex credentialing issues, payer discrepancies, and provider enrollment concerns • Partner with payers, providers, clients, and internal departments to research and resolve issues • Ensure provider information and credentialing documentation is maintained accurately and securely • Oversee verification of licenses, certifications, education, training, work history, sanctions, exclusions, malpractice coverage, and other required information • Ensure compliance with payer requirements, regulatory standards, client expectations, company policies, HIPAA, NCQA standards, and applicable federal and state regulations • Partner with Operations, Client Success, Revenue Integrity, Quality, Compliance, and The People Team • Develop and implement process improvements, automation, standardization, and workflow optimization • Lead implementation of new credentialing processes, payer requirements, systems, and client initiatives • Conduct one-on-one meetings, team meetings, coaching sessions, and performance reviews • Support recruitment, onboarding, training, and development of credentialing teammates • Develop high-performing teammates for future leadership roles • Partner with The People Team on employee relations, performance management, corrective actions, and employment-related concerns • Maintain stakeholder relationships and communicate credentialing status and escalations • Prepare and present operational reports and performance updates to senior leadership • Maintain current knowledge of credentialing regulations, payer requirements, healthcare standards, and regulatory changes • Participate in special projects and perform additional duties as assigned

🎯 Requisitos

• High school diploma or equivalent required • Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred • Minimum three years of credentialing, provider enrollment, healthcare operations, or related experience • Minimum two years of supervisory or management experience preferred • Strong knowledge of provider credentialing, recredentialing, payer enrollment, and provider data management processes • Working knowledge of healthcare payer requirements and credentialing standards • Experience managing team performance and operational metrics • Strong analytical and problem-solving skills • Excellent written, verbal, and interpersonal communication skills • Demonstrated ability to coach, mentor, and develop team members • Strong organizational and time management skills • Proficiency in Microsoft Office Suite, including Excel, Outlook, Word, Teams, and PowerPoint • Ability to work effectively in a fast-paced, deadline-driven environment • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification desired • Experience with CAQH, PECOS, NPPES, state licensing systems, and payer enrollment portals desired • Experience working with credentialing software or provider data management systems desired • Knowledge of NCQA, CMS, Medicare, Medicaid, and commercial payer credentialing requirements desired • Experience managing credentialing for multiple clients, health systems, or provider groups desired • Experience leading process improvement and workflow optimization initiatives desired • Experience managing remote or hybrid teams desired • Demonstrated success improving credentialing turnaround times, quality, and operational efficiency desired • Experience developing reports and analyzing credentialing performance metrics desired