Credentialing and Administrative Support Specialist
Vail Health
Credentialing Manager/Director
Integrated Dermatology
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Develop, implement, and enforce policies and procedures for credentialing and payer enrollment across all states and markets
- Oversee the full lifecycle of credentialing and recredentialing for providers, ensuring accuracy, compliance, and timeliness
- Lead, mentor, and manage credentialing and enrollment staff, including performance management, training, and team development
- Ensure accurate, up-to-date provider data in internal systems and payer portals
- Monitor and maintain compliance with CMS, NCQA, URAC, federal/state regulations, and payer-specific requirements
- Collaborate cross-functionally with finance, contracting, revenue cycle, legal, operations, and clinical leadership to support timely provider onboarding and billing readiness
- Serve as the primary point of contact for escalated issues with payers, regulatory agencies, and partner practices
- Maintain strong relationships with payer representatives and credentialing contacts
- Provide regular status updates and reports to executive leadership, including key performance indicators (KPIs), risk areas, and opportunities for process improvement
Requirements
- Bachelor’s degree required in healthcare administration, business, or related field
- Minimum 5 years of experience in non-delegated healthcare credentialing and payer enrollment, with at least 2 years in a leadership capacity
- Deep understanding of credentialing standards, payer enrollment protocols, and federal/state regulatory requirements
- Hands-on experience with PECOS, CAQH, NPPES, Availity, and other credentialing/enrollment platforms
- Technically proficient with Microsoft Office and credentialing management systems (e.g., Verity, Medallion, Modio, or similar)
- Proven ability to manage confidential and sensitive information with discretion
Benefits
- All your information will be kept confidential according to EEO guidelines.
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialingpayer enrollmentcomplianceperformance managementtrainingprocess improvementdata managementrisk managementreportingKPI analysis
Soft skills
leadershipmentoringcollaborationcommunicationrelationship managementorganizational skillsdiscretionproblem-solvingteam developmentcross-functional collaboration
