Director of Credentialing

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November 22

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American Family Care

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Healthcare • Urgent Care • Family Care

American Family Care is a nationwide healthcare provider specializing in urgent care, primary care, and family care services. With a strong emphasis on accessibility and convenience, they offer a range of medical services including seasonal allergy treatment, vaccinations, physical exams, and emergency care, all designed to ensure prompt attention and a warm, caring environment for patients. American Family Care aims to deliver high-quality healthcare at lower costs compared to traditional emergency room visits, utilizing walk-in clinics and on-site labs to enhance patient experience.

1001 - 5000 employees

Founded 1982

📋 Description

• Provide strategic leadership for all credentialing, recredentialing, privileging, and provider enrollment activities. • Build, lead, and mentor a high-performing credentialing team with appropriate staffing, training, accountability, and performance management. • Develop and implement departmental goals, SOPs, KPIs, and quality assurance measures. • Facilitate training, ongoing education, and change management as credentialing systems and requirements evolve. • Oversee verification of licensure, education, training, certifications, work history, malpractice coverage, and professional references. • Establish proactive workflows for managing all expirable items, including license, certification, and insurance renewals. • Ensure accurate management of provider files, credentialing data, and documentation within credentialing software platforms. • Direct the privileging process in collaboration with medical leadership, department chiefs, and compliance teams. • Ensure compliance with all federal, state, and local regulatory bodies including CMS, The Joint Commission, NCQA, URAC, and commercial payer standards. • Maintain up-to-date knowledge of regulatory changes and lead revisions to policies, procedures, and workflows accordingly. • Oversee timely and accurate submission of enrollment applications with Medicare, Medicaid, and commercial payers. • Track and manage enrollments, revalidations, payer updates, and expirables to prevent reimbursement delays or claim denials. • Manage external credentialing and verification vendors, ensuring high performance, compliance, service quality, and contractual adherence. • Collaborate with IT, Managed Care, Compliance, and Operations on cross-functional systems and technology initiatives.

🎯 Requirements

• Bachelor’s degree in healthcare administration, business, or related field. • 7 or more years of credentialing experience in a healthcare organization, MSO, medical group, ASC, hospital, or health plan. • 3 or more years of leadership or management experience. • Strong working knowledge of CMS, Joint Commission, NCQA, URAC, and payer credentialing and enrollment requirements. • Proficiency with credentialing software systems, provider databases, and digital document management.

🏖️ Benefits

• 401(k) • Health insurance • Opportunity for advancement