Credentialing & Contracting Manager

🔥 0 minutes ago

🇱🇰 Sri Lanka – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 15%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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NIVA Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🛡️ Insurance

⚕️ Healthcare Insurance

Consulting • Insurance • Healthcare Insurance

NIVA Health is a healthcare provider focused on natural pain relief and renewal through cutting-edge therapies. They specialize in a variety of treatments, including IV Vitamin Therapy, wound care, and solutions for conditions such as erectile dysfunction, joint pain, and neuropathy. With multiple locations, they aim to help patients avoid unnecessary surgeries and medications while promoting overall wellness and vitality.

📋 Description

• Own the credentialing process from accepted offer through provider readiness and ongoing maintenance. • Manage and hold the third-party credentialing vendor accountable for timelines, quality, service levels, and results. • Establish credentialing priorities based on provider start dates, patient access, business growth, geographic expansion, and payer requirements. • Lead status reviews, identify barriers and delays, and escalate risks affecting provider start dates or patient care. • Oversee provider contracting, including employment, independent contractor, collaborative practice, supervising physician, medical director, telehealth, delegation, and related agreements. • Ensure provider contracts are executed before patient care begins and maintain renewal and expiration schedules. • Oversee Medicare, Medicaid, and commercial payer enrollment and maintain accurate enrollment reporting. • Partner with Revenue Cycle and Billing to resolve enrollment-related claims and reimbursement issues. • Own provider lifecycle maintenance, including licenses, certifications, DEA registrations, malpractice coverage, collaborative agreements, practice locations, supervising physicians, and state expansions. • Lead credentialing and contracting activities for provider offboarding, including payer notifications, contract terminations, and system updates. • Maintain complete, current, audit-ready provider files. • Develop KPIs, dashboards, SOPs, and reporting for leadership visibility into credentialing performance. • Identify opportunities for automation, process improvement, and standardization. • Serve as NIVA Health’s subject matter expert on provider credentialing operations. • Partner with HR, Clinical Operations, Revenue Cycle, Billing, Finance, Compliance, Legal, and Executive Leadership.

🎯 Requirements

• 5+ years of progressive experience in provider credentialing, payer enrollment, provider contracting, or healthcare operations. • Strong working knowledge of Medicare, Medicaid, and commercial payer enrollment. • Experience with provider credentialing and contracting, including collaborative practice agreements. • Experience managing multiple provider onboarding and credentialing projects simultaneously. • Experience managing or holding a third-party credentialing vendor accountable. • Strong organizational and project management skills. • Advanced Microsoft Excel and reporting skills. • Experience working with provider databases and credentialing software. • Excellent written and verbal communication skills. • Bachelor's degree in Healthcare Administration, Business Administration, Human Resources, or a related field is preferred.