Credentialing Manager
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Job Description
Credentialing Manager at Sleep Doctor overseeing organizational provider credentialing processes and team management. Ensuring compliance with regulations while managing relationships with insurance plans and audits.
Responsibilities:
- Maintain strict alignment with NCQA, URAC, Joint Commission, CMS, and state regulatory guidelines.
- Design, implement, and audit internal quality control processes to ensure zero gaps in provider files.
- Serve as the lead coordinator for all external facility and plan audits.
- Manage relationships with major commercial insurance plans, Medicare, and Medicaid.
- Monitor key performance indicators (KPIs) like "Days to Enroll" and proactively resolve complex application rejections to protect organizational cash flow.
- Collaborate closely with the Compliance, Billing, Legal, Clinical and Revenue operations teams to troubleshoot credentialing-related claim denials.
- Oversee the accuracy and security of the credentialing database.
- Ensure CAQH profiles, NPPES data, and state license renewals are updated systematically across the entire roster.
- Oversee the full lifecycle of state-level licensing, managing both individual provider credentials (state medical boards, DEA, and controlled substance certificates) and facility-level DME operating licenses, out-of-state distribution permits, and surety bond renewals across all active markets.
Requirements:
- Minimum of 6+ years of healthcare credentialing experience, with at least 1–2 years in a supervisory or lead specialist role.
- Bachelor’s degree in Healthcare Administration, Business Administration, or a related field preferred (equivalent direct experience will be considered).
- CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) is required.
- Mastery of CAQH, PECOS, and standard credentialing software.
- Exceptional attention to administrative detail, strong verbal communication (for negotiating with insurance representatives), and proven ability to handle sensitive, confidential provider information.
Benefits:
- medical, vision, and dental insurance
- XX% of the employee medical, vision, & dental premiums covered by the Company
- option to participate in both a medical FSA and dependent care FSA
- 401(k) plan with fully matching contributions up to 3% of salary and 50% matching from 3% to 5% of salary
- Paid Time Off in accordance with the company’s policies
- commuter benefits for Seattle-based employees
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