Credentialing Specialist/SME

Credentialing Specialist

Join our growing healthcare team in the vibrant city of Chicago! We are actively seeking an experienced and strategic professional to take on the role of Manager of Credentialing and Credential Verification (CVO). This role provides a significant learning & growth opportunity for someone who is looking to expand their experience in consultative credentialing services working with top talent across the globe.

Key Responsibilities:

• Lead and oversee a team that oversees the end to end Licensing/ CVO, Credentialing and Privilege processes to ensure compliance with industry standards and regulations.
• Process physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing
• Daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources
• Analyze local payor IPA markets for partnerships or payer contracting opportunities
• Perform primary source verification via various state and national sources
• Oversees, updates and maintains provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies
• Develops and prepares analytical reports monthly/quarterly of the summary of credentialing activity
• Responds timely to provider inquiries by letter, phone or internal communication
• Work closely and maintain relationships with provider relations at each payer, and communicates any challenges and/or concerns with manager timely
• Mentor and coach the team to provide highest levels of service and efficiency
• Maintain relationships with key Payers to facilitate negotiation of contracts
• Collaborate with internal departments to streamline and optimize credentialing operations.
• Manage client relationships and provide high customer satisfaction
• Develop and implement policies and procedures to maintain the highest standards of credentialing excellence in the internal teams.
• Stay informed about changes in accreditation and certification requirements and update processes accordingly.
• Provide thought leadership via adoption of best practices based on industry changes and technology adoption.

Qualifications:

• Bachelor's degree in healthcare administration, Business, or a related field; master's degree preferred.
• 6 to 10 years of experience in credentialing, with substantial experience in a leadership role.
• In-depth knowledge of credentialing processes, privileging, and regulatory requirements.
• Established relationship with key payers will be a plus
• Strong organizational and project management skills.
• Excellent communication skills
• Skilled in preparing and delivering presentations to C Suite stakeholders.

Location: Chicago, IL

If you are a dynamic leader with a proven track record in credentialing and are ready to make a significant impact on our organization, we want to hear from you! Join us in the heart of Chicago and be part of a collaborative and innovative healthcare environment.

To apply, submit your resume to [email protected] with the subject line "Director/Manager - Credentialing & CVO Application - Chicago."

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Job Type: Full-time

Benefits:

• Health insurance

Schedule:

• 8 hour shift

Work Location: Hybrid/Remote