Credentialing and Payer Enrollment Leader

Job Summary

A company is looking for an AVP, Credentialing & Payer Enrollment.

Key Responsibilities

• Oversee all aspects of provider credentialing and payer enrollment on a national level
• Lead a national team to ensure consistency in hiring, training, and skill development
• Ensure compliance with government and health plan requirements related to provider certification and credentialing

Required Qualifications

• 10+ years of experience in managed care credentialing, billing, or medical staff service setting
• Ability to function independently and manage multiple projects
• Experience with NCQA, Joint Commission, URAC, CMS, and state laws regarding provider credentials
• Familiarity with athena and EPIC systems preferred
• Strong organizational skills and executive presence for effective communication with stakeholders