American Family Care
The nation's leading provider of urgent care and accessible primary care. 370+ locations nationwide
Director of Credentialing
Location
United States
Posted
114 days ago
Salary
$115K - $130K / year
Bachelor Degree7 yrs expEnglish
Job 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.
Job 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
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