our Key Responsibilities

• Manage provider enrollment & credentialing: Lead the full credentialing lifecycle for new and existing providers and practice locations — including Medicare (PECOS), Medicare Advantage plans, and other payers.
• Maintain provider data: Ensure CAQH profiles are complete, current, and accurately reflect provider credentials and practice information.
• Optimize workflows: Assess current credentialing processes, identify inefficiencies, and implement improvements using Airtable, automation tools, and best practices.
• Develop SOPs: Write, maintain, and iterate standard operating procedures for credentialing functions and integrate them into operational practice.
• Monitor compliance: Track credentialing status, re-credentialing deadlines, notices, and plan requirements to ensure uninterrupted provider participation in payer networks.
• Communicate across teams: Partner with internal stakeholders — including Clinical Operations, Payer Strategy, and Provider Growth — to align priorities and share updates on credentialing progress and blockers.
• Provider support: Serve as a credentialing point of contact for providers and internal teams, answering questions and coordinating documentation submissions.

   

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