GRS Talent
Director of Credentialing & Payor Enrolment – Ophthalmology
GRS Talent, New York, New York, us, 10261
Director of Credentialing & Payor Enrolment – Ophthalmology
Location:
Northeast US (Remote with periodic regional travel)
Reports To:
Vice President, Revenue Cycle Management
About the Role
Applicants must have recent experience leading credentialing and payor enrolment within an multi-specialty healthcare provider organization.
We are seeking a
Director of Credentialing & Payor Enrolment
to oversee all credentialing, payor enrolment, and compliance functions for our Northeast operations. This leader will ensure providers are accurately and efficiently credentialed across multiple states, supporting both operational growth and revenue integrity.
Key Responsibilities
Credentialing Leadership:
Manage all provider credentialing activities for ophthalmologists, optometrists, and clinical staff across the Northeast.
Payor Enrollment:
Oversee provider enrollment with commercial insurers, Medicare, and Medicaid to ensure timely participation and revenue capture.
Process Optimization:
Develop and implement standardized workflows, automation, and tracking systems to improve efficiency and accuracy.
Team Management:
Lead and mentor a credentialing and enrollment team, fostering accountability, accuracy, and collaboration.
Cross-Functional Collaboration:
Work closely with Operations, Revenue Cycle, Compliance, and M&A Integration teams to ensure smooth onboarding of new providers and practices.
Regulatory Compliance:
Maintain adherence to NCQA, CMS, and state-specific requirements; prepare for audits and maintain thorough documentation.
Data Integrity:
Ensure provider credentialing and enrollment data is accurate, complete, and up to date in internal systems and third-party databases (e.g., CAQH, PECOS).
Reporting & Analytics:
Develop dashboards and reports to monitor credentialing turnaround times, enrollment status, and readiness for billing.
Integration Support:
Lead credentialing and payor enrollment efforts during acquisitions, ensuring minimal revenue disruption and compliance alignment.
Qualifications
Required:
5+ years of recent experience managing credentialing and/or payor enrollment in an
ophthalmology or optometry provider network .
Strong knowledge of payer credentialing requirements, Medicare/Medicaid enrollment, and NCQA/URAC standards.
Experience leading a multi-state credentialing operation within the Northeast region.
Proficiency with credentialing software and databases (e.g., VerityStream, Modio, IntelliSoft, CAQH).
Excellent leadership, communication, and project management skills.
Bachelor’s degree required; CPCS or CPMSM certification preferred.
Seniority Level Director
Employment Type Full-time
Job Function Administrative
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Northeast US (Remote with periodic regional travel)
Reports To:
Vice President, Revenue Cycle Management
About the Role
Applicants must have recent experience leading credentialing and payor enrolment within an multi-specialty healthcare provider organization.
We are seeking a
Director of Credentialing & Payor Enrolment
to oversee all credentialing, payor enrolment, and compliance functions for our Northeast operations. This leader will ensure providers are accurately and efficiently credentialed across multiple states, supporting both operational growth and revenue integrity.
Key Responsibilities
Credentialing Leadership:
Manage all provider credentialing activities for ophthalmologists, optometrists, and clinical staff across the Northeast.
Payor Enrollment:
Oversee provider enrollment with commercial insurers, Medicare, and Medicaid to ensure timely participation and revenue capture.
Process Optimization:
Develop and implement standardized workflows, automation, and tracking systems to improve efficiency and accuracy.
Team Management:
Lead and mentor a credentialing and enrollment team, fostering accountability, accuracy, and collaboration.
Cross-Functional Collaboration:
Work closely with Operations, Revenue Cycle, Compliance, and M&A Integration teams to ensure smooth onboarding of new providers and practices.
Regulatory Compliance:
Maintain adherence to NCQA, CMS, and state-specific requirements; prepare for audits and maintain thorough documentation.
Data Integrity:
Ensure provider credentialing and enrollment data is accurate, complete, and up to date in internal systems and third-party databases (e.g., CAQH, PECOS).
Reporting & Analytics:
Develop dashboards and reports to monitor credentialing turnaround times, enrollment status, and readiness for billing.
Integration Support:
Lead credentialing and payor enrollment efforts during acquisitions, ensuring minimal revenue disruption and compliance alignment.
Qualifications
Required:
5+ years of recent experience managing credentialing and/or payor enrollment in an
ophthalmology or optometry provider network .
Strong knowledge of payer credentialing requirements, Medicare/Medicaid enrollment, and NCQA/URAC standards.
Experience leading a multi-state credentialing operation within the Northeast region.
Proficiency with credentialing software and databases (e.g., VerityStream, Modio, IntelliSoft, CAQH).
Excellent leadership, communication, and project management skills.
Bachelor’s degree required; CPCS or CPMSM certification preferred.
Seniority Level Director
Employment Type Full-time
Job Function Administrative
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