Director of Credentialing

Company Overview

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team

Theoria's FinanceDepartment is seeking individuals to join its team to oversee and optimize the payer enrollment and credentialing of our physician group. The Credentialing Director will be responsible for managing the payer enrollment and credentialing process, timely provider enrollments, and resolving any credentialing-related issues that arise. This role will work directly with the Revenue Cycle Management team as well. The candidate must have extensive experience in healthcare credentialing, revenue cycle management, and strong leadership and communication skills.

Shift Structure

• Monday- Friday and some weekends 8:30am-5pm EST, flexible
• Remote

Employment Type

• Full-Time, Exempt

Essential Functions and Responsibilities

• Analyze, lead and manage the credentialing operations, including but not limited to communication with providers, CAQH management, enrollment applications
• Oversee a credentialing team
• Assist with and perform payer enrollment applications
• Manage credentialing vendor relationships
• Coordinate with the revenue cycle management team on credentialing denials
• Develop and implement policies and procedures to ensure accurate and timely submission of payer enrollment applications
• Identify and resolve revenue cycle issues related to credentialing / payer enrollment
• Monitor and analyze revenue cycle metrics, including accounts receivable aging, claim submission and payment turnaround times, and denial rates related to credentialing
• Develop and maintain strong relationships with HR and operations departments to ensure a smooth credentialing process.
• Monitor and manage the entire credentialing and payer enrollment process from A-Z
• Review and respond to various payor correspondence

Requirements and Qualifications

• Bachelor's degree in healthcare administration or related field
• 7+ years of experience in credentialing/payer enrollment in a healthcare setting
• Advanced knowledge of the healthcare industry and a strong financial background
• Clear understanding of billing and collection regulatory guidelines and requirements
• Vast knowledge in credentialing and payor management
• Proficient background in reimbursements
• Experience in monitoring Clearinghouse activity, reports, and processes
• Experience in setting up payors with EDI, ERA, and EFT processes
• Knowledge and experience in startup of a new or established credentialing engagement
• Experience in managing and leading a team of Credentialing professionals
• Strong analytical skills and attention to detail
• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment and manage multiple projects simultaneously
• Agility, strong leadership, problem-solving skills
• Working knowledge of Google Drive and Google suite of applications
• Ability to maintain up-to-date knowledge of Technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS Teams
• Must have reliable internet connection

Physical Requirements

• Must be punctual or on time and adhere to the company's Time and Attendance policy.
• Must be able to remain sitting for the majority of their shift.

Compensation and Benefits

• Salary $105,000-$125,000
• 401k
• Health and dental insurance
• PTO and holiday pay

Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.

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