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Director of Credentialing

  • 0 yrs
  • $ Not Disclosed / YEAR

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Job Description

Overview


United Vein & Vascular Centers is a rapidly growing healthcare company headquartered in Tampa, Florida with numerous clinics throughout Florida, Colorado, Arizona, and Illinois.  Our practices specialize in office-based, minimally invasive venous surgery.  United Vein & Vascular Centers consistently values, recognizes and rewards their team members and has unprecedented organizational culture and leadership.  Come join our growing team!


Responsibilities


$10,000.00 SIGN-ON BONUS!


 


The Director of Credentialing will develop, manage, and grow relationships with payors and providers. This individual will be responsible for strategic planning, identifying and evaluating opportunities, leading outreach, and directing contract negotiations with current and prospective payors and/or healthcare providers. This position will be responsible for overseeing and managing the Credentialing Manager to optimize efficiencies in payor enrollment within the credentialing process.



  • Develop the strategy, objectives, techniques, and tactics to achieve the strategic goals of the department.

  • Develop financial and market analysis in preparation for negotiations.

  • Negotiations of payor contracts.

  • Provide managed care and contracting guidance/expertise to other departments.

  • Recognize revenue opportunities and develop a strategy to incorporate them into existing and future contracts.

  • Stay abreast of financial and managed care regulations, how it impacts the organization and provide reporting to leadership.

  • Participate in the managed care revenue forecasting process.

  • Work closely with senior leadership to formulate and implement early-stage, foundational strategies and initiatives for payor contracting and expand provider network.

  • Manage the contracting process, developing rate methodologies to maximize the performance of managed care contracts.

  • Stay informed about new payor opportunity in each market and awareness of regulatory payor guidelines.

  • Oversee and manage the credentialing department as a whole.  

  • Create and execute a strategy for our payor portfolio from start to finish, including research, outreach, and negotiation.

  • Other duties as assigned.


Qualifications



  • Bachelor's degree in Finance, Accounting, Healthcare Administration, Business or similar field required.  Masters degree preferred.

  • 8-10 years of progressive supervisory work experience in provider network contracting, managed care, healthcare operations or related area.

  • Must have experience credentialing for 20+ providers per year.

  • Multi-state experience preferred.

  • Extensive and comprehensive knowledge of the payor and provider market, both regional and national.

  • Demonstrated history of successful payor negotiations and outcomes with large regional and national payors.

  • Broad and deep understanding of healthcare reimbursement methodologies required.

  • Strong industry acumen of payor business models and how innovations in healthcare will impact the future of reimbursement.

  • Demonstrated experience building programs or operational processes from scratch.

  • Strong team management and leadership skills.

  • Strong analytical and communication skills.

  • Dependable; able to meet reliable attendance and punctuality standards.


We Offer:



  • Competitive compensation package

  • Health, vision and dental benefits

  • 401K plan

  • Life insurance (100% company paid)

  • PTO and paid holidays


 


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