| Licensing & Credentialing Manager
Licensing & Credentialing Manager |
Licensing & Credentialing Manager |
<p class="MsoNormal" style="margin-bottom:0in"><span style="font-family: Calibri, sans-serif; font-size: 11pt;">The Licensing &Credentialing Manager plays a key role in building and maintaining our payernetwork. This position oversees licensing, credentialing, and providerenrollment processes in line with company policies, industry standards, andregulatory requirements. Responsibilities include securing payer contracts innew and existing markets, ensuring timely enrollment with public and privatepayers, managing licensing and credentialing activities, and resolvingenrollment or billing issues. This role ensures clinicians maintain currentcredentials and licenses to practice in their specialty.</span></p><p class="MsoNormal" style="margin-bottom:0in"><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif"><span style="font-weight: bold;">Essential Functions:</span><o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0in"><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif"><span style="font-weight: bold;">Payer Network Development:</span><o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0in"><ul><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Lead payer contractprocurement from outreach to execution</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Negotiate terms withnational and regional payers</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Build and maintain payerrelationships across markets</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Monitor and manage contractsthrough their lifecycle</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Partner with legal andfinance to ensure compliance</span></li></ul></p><p class="MsoNormal" style="margin-bottom:0in"><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif"><span style="font-weight: bold;">Data Analysis &Reporting</span><o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0in"><ul><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Analyze enrollment data toimprove processes</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Track contract performance,utilization, quality, and denials</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Provide reports onenrollment, licensing, and credential compliance</span></li></ul></p><p class="MsoNormal" style="margin-bottom:0in"><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif"><span style="font-weight: bold;">Licensing &Credentialing:</span><o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0in"><ul><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Manage licensing andcredentialing activities with third-party partners</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Maintain accurate records,monitor expirations, and oversee renewals</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Ensure compliance with alllaws, regulations, and accreditation standards</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Implement efficientprocedures to streamline enrollment</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Serve as the main contactfor licensing, credentialing, and enrollment inquiries</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Actively participate inCredentialing Committee discussions</span></li></ul></p><p class="MsoNormal" style="margin-bottom:0in"><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif"><span style="font-weight: bold;">Qualifications:</span><o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0in"><ul><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Bachelor’s degree inBusiness, Healthcare Administration, or related field</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">2–4 years of experience inpayer contracting, ideally in telehealth</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Skilled in negotiating andmanaging contracts across multiple payers</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Strong knowledge of payerfee schedules, credentialing requirements, and regulatory bodies (CMS, NCQA,etc.)</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Experience withcredentialing software or third-party vendors</span></li><li><span style="font-size:11.0pt;line-height:115%;font-family:"Calibri",sans-serif">Ability to maintain HIPAAcompliance and manage confidential information</span></li></ul></p> |