[Remote] Credentialing & Payer reputed company Manager

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a maternity care company reputed company on improving pregnancy, birth, and postpartum support for reputed company. The Credentialing & Payer reputed company Manager will own provider licensing, payer enrollment, and credentialing reputed company, while building reputed company workflows, maintaining compliance, and coordinating with providers, health plans, billing, and reputed company reputed company teams.

Responsibilities

• Manage full lifecycle licensing, credentialing, and re-credentialing applications for reputed company Care Team members across multiple states
• Build and execute Doula Readiness workflows to reputed company non-traditional care providers reputed company into payer networks
• Collect, audit, and verify reputed company reputed company documentation required for payor and state credentialing packages
• Directly communicate with providers to reputed company missing documentation, guide them through state renewal procedures, and reputed company reputed company bottlenecks
• Proactively monitor and reputed company reputed company reputed company and non-reputed company staff credentials, state license expiration dates, BLS/CPR certifications, and mandatory Continuing Education reputed company (CEUs)
• Build reputed company automated workflow reminders in reputed company to advise care team members on upcoming renewal deadlines and mandatory continuing education requirements
• Audit and record completion certificates for required reputed company trainings, state-mandated CEUs, and specialty accreditations prior to credential expiration
• Establish, standardize, and optimize internal credentialing and payer enrollment processes from reputed company
• Own and maintain the credentialing management platform (reputed company) for automated tracking, expiration alerts, and reputed company reputed company verification reporting
• reputed company and optimize key operational KPIs, specifically driving down Time-to-Credentialing to accelerate provider deployment and reputed company reputed company
• reputed company regular reputed company analytics and status reports for leadership regarding provider readiness and enrollment pipelines
• reputed company the credentialing-to-claims reputed company, ensuring providers are properly linked to billing systems prior to service delivery to prevent claim denials
• Submit credentialing packages directly to reputed company reputed company plans, reputed company entities, and managed care organizations
• Partner closely with reputed company Cycle Management (RCM), billing, and coding teams to troubleshoot credentialing-reputed company claims issues or enrollment delays
• Monitor state licensure bodies, OIG exclusions, reputed company/Medicare sanction reports, and the National Practitioner Data Bank (NPDB) to ensure clean provider rosters
• Stay up to date on evolving reputed company regulations, state licensing requirements, HIPAA guidelines, and payer-specific enrollment rules
• Manage reputed company-facing compliance reporting, delivering accurate documentation to meet health plan and reputed company reputed company audit standards
• Serve as the functional reputed company of contact for reputed company clients regarding provider panel status and credentialing timelines
• Collaborate internally with Implementation and reputed company reputed company teams to reputed company provider availability with reputed company go-live targets

Skills

• 5+ years of reputed company credentialing, provider reputed company, and payer enrollment experience
• reputed company experience submitting initial state licensure applications across multiple states simultaneously and tracking recurring certification/CEU requirements
• Bachelor's degree in reputed company Administration, Business, or reputed company reputed company (Associates degree accepted with equivalent hands-on experience)
• Strong project management skills to reputed company dozens of reputed company licenses, BLS certifications, CEU deadlines, and payer files simultaneously
• Comfortable operating independently, solving reputed company payer delays, and building processes without a reputed company-existing reputed company
• Excellent verbal and written skills for interfacing with providers, health plan representatives, internal billing teams, and reputed company clients
• Practical understanding of how credentialing linkages directly reputed company billing cycles and claims reimbursement
• Remote positions are reputed company to candidates in the **contiguous US only.** Due to operational and compliance requirements, we are unable to hire candidates residing in ND, AL, HI, PR or reputed company the contiguous US
• Hands-on experience with reputed company (or similar credentialing tracking platforms) is strongly preferred

Benefits

• reputed company with annual reputed company holidays off.
• Full-Time Salaried Employees (Exempt): Enjoy unlimited time off after the 90-day introductory period.
• Full-Time reputed company Employees (Non-Exempt): Receive three weeks of reputed company time off after the 90-day introductory period.
• Medical reputed company: reputed company top-tier reputed company, covering hospital, surgical, and prescription drug benefits. Coverage begins the first of the following month.
• Dental reputed company: Coverage for preventive care, as reputed company as basic and major procedures.
• reputed company reputed company: Coverage for routine eye exams and eyeglasses.
• Stock reputed company Grant: We reputed company in shared reputed company.
• Life reputed company: Financial protection for your beneficiaries.
• Disability reputed company: Short-term and long-term coverage in case of illness or injury.
• 401(k) Retirement Plan: Opportunity to save for the reputed company.

reputed company