Director of Credentialing, Licensing & Payer Enrollment

📋 Description

• • As the Director of Provider Credentialing, Licensing & Payer Enrollment at AnswersNow, you will be at the forefront of ensuring our innovative virtual ABA therapy services can reach families nationwide. This pivotal leadership role is responsible for the comprehensive strategic oversight, meticulous execution, and continuous enhancement of all provider credentialing, re-credentialing, payer enrollment, contracting coordination, and licensure activities across every AnswersNow business entity.
• • This is a high-visibility position, absolutely critical to enabling the swift onboarding of our valued providers, facilitating our ambitious multi-state expansion plans, and driving robust revenue generation. Your expertise will ensure that our providers and provider groups are credentialed, contracted, and licensed with unparalleled accuracy and efficiency, thereby eliminating any delays in service delivery, billing, and reimbursement.
• • You will lead and mentor a dedicated credentialing team, expertly manage relationships with external vendors, and foster strong cross-functional partnerships with key departments including Revenue Cycle Management (RCM), Growth, Operations, Scheduling, and Technology. A core part of your role will involve delivering clear, data-driven reports and strategic insights to our executive leadership team, keeping them informed of progress, challenges, and opportunities.
• • Your primary objective will be to significantly reduce the time-to-credential and time-to-payer-ready for both new and existing providers, particularly as we expand into new states. This means streamlining processes and proactively addressing potential bottlenecks.
• • You will be the guardian of our credentialing and licensure records, ensuring they are consistently accurate, meticulously organized, and fully audit-ready at all times. Maintaining impeccable compliance with all state, federal, and payer-specific credentialing requirements is paramount.
• • A key focus will be on designing and implementing scalable credentialing workflows that are robust enough to support our rapid growth trajectory and extensive geographic expansion. This requires a forward-thinking approach to process design and technology utilization.
• • You will meticulously track vendor performance against defined Service Level Agreements (SLAs), ensuring that our external partners meet our high standards for service and efficiency.
• • You will be responsible for providing clear, concise, and actionable executive-level reporting on all aspects of credentialing performance, highlighting key priorities, identifying potential risks, and proposing effective mitigation plans.
• • Your leadership will extend to coaching, mentoring, and developing the Credentialing & Licensing team, fostering a culture of excellence, continuous improvement, and professional growth.
• • You will collaborate closely with the Provider Onboarding and Growth teams, acting as a central point of contact to ensure all necessary documentation is collected promptly and credentialing processes are initiated without any undue delay.
• • You will oversee the critical review and validation of all practitioner applications, ensuring completeness and accuracy before submission.
• • You will own the end-to-end payer enrollment and credentialing activities, including the coordination and submission of payer contracting documentation.
• • You will be the primary owner of our credentialing systems, vendors, and tools, including but not limited to CAQH, NPPES, various payer portals, and our internal platforms, ensuring their optimal utilization and maintenance.
• • You will champion a culture of compliance and operational excellence, staying abreast of evolving regulations and best practices in the healthcare credentialing and enrollment landscape.
• • By ensuring seamless and efficient provider credentialing and enrollment, you will directly contribute to AnswersNow's mission of making autism therapy more accessible and effective for families across the country, solidifying our position as a leader in the telehealth space.