Credentialing Supervisor

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Lighthouse Autism Center

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Private Equity Round on 2021-07

Healthcare • Healthcare Insurance

Lighthouse Autism Center is a dedicated facility providing comprehensive therapy services for children with autism. With over a decade of experience, they offer a wide range of personalized, evidence-based therapeutic approaches such as ABA therapy, speech therapy, and school readiness programs. Their compassionate and clinically excellent team aims to unlock each child's unique strengths and potential in a nurturing environment, supporting families in the Midwest. Through innovative models like the Lighthouse Fusion approach, they make a significant difference in the developmental paths of children on the autism spectrum.

📋 Description

• Lead the provider credentialing and enrollment team, establishing priorities, monitoring performance, and fostering professional development • Oversee provider onboarding activities related to credentialing, payer enrollment, and readiness for clinical practice • Ensure timely completion of initial credentialing, recredentialing, and payer enrollment across contracted health plans • Manage provider maintenance, including demographic updates, licensure monitoring, CAQH maintenance, payer roster updates, and revalidation • Develop and improve credentialing workflows, policies, and standard operating procedures • Collaborate with Clinical Operations, Human Resources, Compliance, and Revenue Cycle teams • Escalate complex credentialing and enrollment issues with payers, delegated credentialing organizations, and regulatory agencies • Monitor credentialing metrics, turnaround times, and key performance indicators • Maintain accurate credentialing records and documentation across credentialing systems and payer portals • Coordinate credentialing for new locations, payer contracts, and acquisitions • Build and maintain relationships with payer representatives and external credentialing partners

🎯 Requirements

• Exceptional organizational skills, attention to detail, and commitment to accuracy • Ability to lead and manage credentialing operations autonomously and accountably • Strong prioritization and workload management skills • Minimum 3 years of experience in provider credentialing, recredentialing, and payer enrollment • Minimum 2 years of leadership or supervisory experience preferred • Experience leading multi-state credentialing and recredentialing operations • Advanced computer proficiency, including Microsoft Office Suite and credentialing, payer, or provider database systems • Experience with credentialing software, data integrity oversight, report generation, and process improvement • Strong verbal and written communication skills • Understanding of confidentiality requirements and ability to manage sensitive information discreetly • Ability to develop, monitor, and improve credentialing processes, policies, and performance metrics • Knowledge of NCQA, CMS, Medicaid, commercial payer, and accreditation-related credentialing requirements • Bachelor’s degree in healthcare administration, Business Administration, Health Information Management, or a related field preferred