Sleep Doctor - Credentialing Manager

Hybrid - USA *$75k - $90k1w ago

In Office Junior NA Insurance Account Manager Quality Control

Responsibilities

• Maintain strict alignment with NCQA, URAC, Joint Commission, CMS, and state regulatory guidelines. • Design, implement, and audit internal quality control processes to ensure zero gaps in provider files. • Serve as the lead coordinator for all external facility and plan audits. • Manage relationships with major commercial insurance plans, Medicare, and Medicaid. • Monitor key performance indicators (KPIs) like "Days to Enroll" and proactively resolve complex application rejections to protect organizational cash flow. • Collaborate closely with the Compliance, Billing, Legal, Clinical and Revenue operations teams to troubleshoot credentialing-related claim denials. • Oversee the accuracy and security of the credentialing database • Ensure CAQH profiles, NPPES data, and state license renewals are updated systematically across the entire roster. • Oversee the full lifecycle of state-level licensing, managing both individual provider credentials (state medical boards, DEA, and controlled substance certificates) and facility-level DME operating licenses, out-of-state distribution permits, and surety bond renewals across all active markets.

Benefits

• $75,000 - $90,000. Note that final compensation is subject to the candidate’s specific qualifications and location, as well as the needs of the company. • The Company currently provides medical, vision, and dental insurance with XX% of the employee medical, vision, and dental premiums covered by the Company. There is an option to participate in both a medical FSA and dependent care FSA. We offer a 401(k) plan, with fully matching contributions up to 3% of salary and 50% matching from 3% to 5% of salary. You will be eligible for Paid Time Off in accordance with the company’s policies. Our Seattle-based employees will receive commuter benefits.