Credentialing Manager

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VaxCare

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Healthcare Insurance • SaaS • B2B

VaxCare is a company that provides an innovative solution for managing vaccine inventory and administration at medical practices. VaxCare ensures that practices have all the vaccines they need at no cost, automating inventory management and billing processes. By simplifying the vaccine administration workflow, integrating with Electronic Health Records (EHRs), and handling all billing payments, VaxCare helps medical practices to increase efficiency, reduce overhead, and enhance patient care. The company's platform not only improves administrative processes but also aids in raising immunization rates, contributing positively to community health.

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $1.5M Debt Financing on 2012-10

📋 Description

• Manage all aspects of the credentialing and recredentialing process for providers and organizational partners. • Supervise daily operations of the credentialing team, ensuring timely processing of applications, verifications, and approvals. • Collaborate closely with Market Access, Legal, Compliance, and Revenue Cycle teams to ensure alignment between credentialing, contracting, and onboarding activities. • Develop and maintain policies and procedures that ensure compliance with payer, CMS, NCQA, and state/federal requirements. • Monitor key performance indicators (KPIs) for accuracy, timeliness, and efficiency in credentialing workflows. • Ensure adherence to regulatory and accreditation standards governing credentialing and privileging processes. • Oversee preparation of files for credentialing review, committee presentation, and payer delegation audits. • Partner with Compliance and Quality teams to ensure providers meet performance, licensing, and background requirements. • Maintain audit readiness and lead credentialing-related responses for internal and external reviews. • Implement, manage, and optimize credentialing platforms (e.g., Symplr or equivalent system) for automation, data integrity, and reporting. • Collaborate with IT and Operations to integrate credentialing data into enterprise systems such as EHR, HR, and payer platforms. • Identify and implement process improvements that reduce turnaround times and enhance provider experience. • Recruit, train, and mentor credentialing staff to ensure consistent quality and regulatory compliance. • Promote a culture of accountability, collaboration, and continuous learning. • Provide ongoing education to internal teams and external partners on credentialing requirements and timelines.

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business, or related field. • Minimum five (5) years of experience in provider credentialing, medical staff services, or payer enrollment, including two (2) or more years in a leadership capacity. • Master’s degree in Healthcare Administration, Business, or related discipline preferred. • Experience with delegated payer credentialing or large multi-state provider networks. • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification through NAMSS preferred, or ability to obtain within 12 months of hire. • Deep understanding of credentialing and payer enrollment requirements (NCQA, CMS, OIG, CAQH, state boards). • Strong proficiency with credentialing software systems and Microsoft Office Suite. • Exceptional organizational, analytical, and problem-solving skills. • Excellent written and verbal communication skills. • Proven leadership and ability to manage cross-functional relationships in a fast-paced environment.

🏖️ Benefits

• Remote Work Requirements: Must be able to perform job duties independently with minimal supervision. • Must have private, distraction-free workspace suitable for confidential and focused work. • Must have reliable high-speed internet to support video conferencing and regular computer use. • Prolonged sitting or standing: Employees must be able to remain in a stationary position for extended periods, as much of the work involves sitting at a computer or workstation. • Some hybrid or office-based roles may also require the ability to stand for portions of a shift. • Repetitive motions: Significant use of the hands, wrists, and fingers is required for tasks like typing, using a computer mouse, and handling paperwork. • Visual acuity: The job requires the ability to view a computer screen and read documents for extended periods. • Communication: Employees must be able to clearly express and exchange ideas in English to effectively communicate with customers and co-workers. • Occasional lifting: Many office-based jobs specify the ability to occasionally lift or move up to 10–20 pounds to handle supplies or equipment.