Responsibilities
- Manages the complete credentialing lifecycle for a network of nurse practitioners
- Designs, executes, and refines processes for credentialing, re-credentialing, and privileging to meet regulatory standards
- Evaluates and audits both delegated and non-delegated credentialing workflows for performance and compliance
- Performs in-depth verification of provider qualifications by reaching out to primary source institutions
- Supports credentialing committee operations, including meeting coordination, preparation, and documentation
- Maintains up-to-date knowledge of legal and regulatory requirements, including NCQA and National Practitioner Data Bank standards
- Implements technology solutions to optimize credentialing workflows and data management
- Engages in discussions with payors during scheduled meetings
- Works jointly with revenue cycle management on credentialing-related enrollment issues and claim denials
Work Arrangement
Remote (Worldwide)
