Credentialing Manager

Job not on LinkedIn

🕒 July 15

☕ Washington – Remote

☕ Washington – Remote

💵 $75k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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SleepDoctor

WebsiteLinkedInAll Job Openings

1 - 10 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

SleepDoctor is a company that specializes in providing comprehensive solutions for sleep-related health issues, both online and at home. They offer diagnostic services for sleep disorders such as sleep apnea and insomnia, providing tailored treatment plans based on scientific research and expert guidance. SleepDoctor also develops specialized software for sleep specialists and other healthcare professionals to integrate into their practices. They are committed to data security and compliance, ensuring the privacy of patient information is maintained. With a team of recognized experts in the sleep medicine field, SleepDoctor aims to promote better sleep health across diverse patient demographics.

📋 Description

• Maintain strict alignment with NCQA, URAC, Joint Commission, CMS, and state regulatory guidelines. • Design, implement, and audit internal quality control processes to ensure zero gaps in provider files. • Serve as the lead coordinator for all external facility and plan audits. • Manage relationships with major commercial insurance plans, Medicare, and Medicaid. • Monitor key performance indicators (KPIs) like "Days to Enroll" and proactively resolve complex application rejections to protect organizational cash flow. • Collaborate closely with the Compliance, Billing, Legal, Clinical and Revenue operations teams to troubleshoot credentialing-related claim denials. • Oversee the accuracy and security of the credentialing database. • Ensure CAQH profiles, NPPES data, and state license renewals are updated systematically across the entire roster. • Oversee the full lifecycle of state-level licensing, managing both individual provider credentials (state medical boards, DEA, and controlled substance certificates) and facility-level DME operating licenses, out-of-state distribution permits, and surety bond renewals across all active markets.

🎯 Requirements

• Minimum of 6+ years of healthcare credentialing experience, with at least 1–2 years in a supervisory or lead specialist role. • Bachelor’s degree in Healthcare Administration, Business Administration, or a related field preferred (equivalent direct experience will be considered). • CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) is required. • Mastery of CAQH, PECOS, and standard credentialing software. • Exceptional attention to administrative detail, strong verbal communication (for negotiating with insurance representatives), and proven ability to handle sensitive, confidential provider information.

🏖️ Benefits

• medical, vision, and dental insurance • XX% of the employee medical, vision, & dental premiums covered by the Company • option to participate in both a medical FSA and dependent care FSA • 401(k) plan with fully matching contributions up to 3% of salary and 50% matching from 3% to 5% of salary • Paid Time Off in accordance with the company’s policies • commuter benefits for Seattle-based employees