Director of Payor Credentialing

Position Type: Full-time, exempt

Compensation: up to $150,000 per year

Job Location: Remote (US)

Job Highlights:

• Work-Life Balance: Monday to Friday schedule for a fulfilling personal and professional life.
• Competitive Compensation: Be rewarded with a generous salary and benefits package.
• Career Growth Opportunities: Unlock your potential and advance in your career with our support.
• Supportive Work Environment: Join a team that values and appreciates your contributions.
• Comprehensive Training: Enhance your skills and knowledge through our extensive training programs.
• Compliance and Peace of Mind: Work with confidence knowing that we prioritize compliance with employment laws and regulations.
• Paid Time Off and Holidays: Enjoy well-deserved time off to relax and recharge.
• Life Insurance Coverage: Protect your loved ones with our employer-paid life insurance policy.
• Collaborative Team Environment: Thrive in a positive and collaborative work environment.

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 Finance Department 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
• 8:30 am-5:00 pm EST, flexible 

Essential Functions and Responsibilities 

• Team Building: Recruit, hire, and lead a credentialing team to manage all aspects of payer enrollment in-house.
• Process Development: Establish credentialing workflows, policies, and procedures to streamline the enrollment process for providers, ensuring efficiency and compliance.
• Payer Enrollment: Oversee and manage the payer enrollment process from start to finish, including application submission, CVO, CAQH management and provider communications.
• Cross-Department Collaboration: Work closely with Revenue Cycle, HR, and Operations to ensure smooth onboarding and credentialing of new providers.
• Revenue Cycle Support: Collaborate with the revenue cycle management team to resolve credentialing-related denials and streamline the reimbursement process.
• Quality Control: Develop internal audit systems to ensure compliance with payer requirements and regulatory standards.
• Reporting: Regularly report on credentialing metrics, including denial rates, enrollment timelines, and financial impact.

Requirements and Qualifications

• Bachelor's degree in healthcare administration or related field
• Minimum of 10 years of experience in healthcare credentialing and payer enrollment, with at least 5 years in a leadership role managing a team.
• Advanced knowledge of the healthcare industry and a strong financial background
• Proven experience building and leading credentialing teams  in a healthcare setting.
• 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 a 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 Benefit

• 401k
• Health and dental insurance 
• PTO and holiday pay 

Employees 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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