Manager

• Own the credentialing process from accepted offer through provider readiness and ongoing maintenance.
• Manage and hold the third-party credentialing vendor accountable for timelines, quality, service levels, and results.
• Establish credentialing priorities based on provider start dates, patient access, business growth, geographic expansion, and payer requirements.
• Lead status reviews, identify barriers and delays, and escalate risks affecting provider start dates or patient care.
• Oversee provider contracting, including employment, independent contractor, collaborative practice, supervising physician, medical director, telehealth, delegation, and related agreements.
• Ensure provider contracts are executed before patient care begins and maintain renewal and expiration schedules.
• Oversee Medicare, Medicaid, and commercial payer enrollment and maintain accurate enrollment reporting.
• Partner with Revenue Cycle and Billing to resolve enrollment-related claims and reimbursement issues.
• Own provider lifecycle maintenance, including licenses, certifications, DEA registrations, malpractice coverage, collaborative agreements, practice locations, supervising physicians, and state expansions.
• Lead credentialing and contracting activities for provider offboarding, including payer notifications, contract terminations, and system updates.
• Maintain complete, current, audit-ready provider files.
• Develop KPIs, dashboards, SOPs, and reporting for leadership visibility into credentialing performance.
• Identify opportunities for automation, process improvement, and standardization.
• Serve as NIVA Health’s subject matter expert on provider credentialing operations.
• Partner with HR, Clinical Operations, Revenue Cycle, Billing, Finance, Compliance, Legal, and Executive Leadership.

Manager jobs in Sri Lanka

Credentialing & Contracting Manager