Director of Credentialing

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🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Director

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Upstream Rehabilitation

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

💰 Private Equity Round on 2015-12

Healthcare • Consulting • Healthcare Insurance

Upstream Rehabilitation is the country's largest dedicated provider of outpatient physical and occupational therapy services. Committed to advancing health, Upstream focuses on clinical excellence through post-doctoral educational programs, structured mentorship, and tracking of patient outcomes. The company offers extensive career opportunities in corporate and clinical roles, fostering an inclusive work environment and investing in professional development. Upstream also supports community outreach through its Pillars with Purpose benevolent funds, encouraging associates to engage in volunteer service. With over 1,200 clinics across the United States, Upstream Rehabilitation provides exceptional care and innovative rehabilitation technologies to empower patients on their healing journeys.

📋 Description

• Provide strategic leadership for provider credentialing, enrollment, recredentialing, delegated credentialing, and compliance programs • Lead, develop, and mentor the credentialing team • Oversee timely, accurate, and compliant provider onboarding, recredentialing, monitoring, and provider-record maintenance across payer networks • Serve as subject matter expert on credentialing, provider enrollment, delegated credentialing, NCQA standards, and regulatory requirements • Direct delegated credentialing programs and payer relationships, including audit readiness, performance reporting, roster management, issue resolution, and delegation-agreement compliance • Partner with Operations, Revenue Cycle, Compliance, Legal, Human Resources, Clinical Leadership, and Payer Contracting on onboarding, clinic growth, acquisitions, relocations, closures, and network participation • Establish, monitor, and report KPIs for credentialing timeliness, enrollment accuracy, audit performance, provider readiness, compliance, and revenue-cycle outcomes • Lead process improvement, automation, and technology initiatives • Develop and maintain credentialing policies, procedures, quality standards, and corrective action plans • Build relationships with providers, executive leadership, field operations, and payer partners to improve provider access, reimbursement, and business performance • Perform other projects and duties as assigned

🎯 Requirements

• Must reside in the United States • Bachelor's degree in Healthcare Administration, Business Administration, Revenue Cycle Management, or a related field; an equivalent combination of education and experience may be considered • 8+ years of progressive experience in healthcare credentialing, provider enrollment, delegated credentialing, provider operations, or revenue cycle management • 5+ years of leadership experience managing credentialing, provider enrollment, or healthcare operations teams • Demonstrated success leading process improvement initiatives, driving operational efficiencies, and managing cross-functional projects • Experience supporting large, multi-state healthcare organizations, preferably within an outpatient or ambulatory care environment • Strong experience managing delegated credentialing programs, payer relationships, and regulatory audits for commercial and government health plans • Deep knowledge of NCQA credentialing standards, delegated credentialing requirements, accreditation processes, and audit readiness activities • Experience utilizing credentialing and enrollment platforms such as CredentialStream, CAQH, PECOS, NPPES, Availity, and commercial payer portals • Experience supporting provider onboarding, de novo clinic openings, acquisitions, relocations, ownership changes, and other organizational growth initiatives • Working knowledge of Medicare DMEPOS enrollment, EFT/CEDI processes, provider data management, and ongoing compliance monitoring programs • CPCS or CPMSM certification is a nice-to-have

🏖️ Benefits

• Annual paid Charity Day to give back to a cause meaningful to you • 100% employer paid medical health insurance premium option available • Dental and Vision insurance • 401(k) with company match • Generous PTO and paid holidays • Supportive team and leadership invested in your success • Competitive compensation • Comprehensive benefits • Ongoing professional development • Leadership development programs • Ongoing education • Professional growth opportunities • Collaborative team environment • Remote and corporate office work options across the organization

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