American Family Care

Compensation

Full Description

Note: The job is a remote job and is open to candidates in USA. American Family Care (AFC) is one of the largest urgent care networks in the U.S. providing services seven days a week on a walk-in basis. The Director of Credentialing is responsible for leading and managing the credentialing operations across all clinics, ensuring compliance with regulatory standards while enhancing the provider experience and operational processes. Responsibilities • Provide strategic leadership for all credentialing, recredentialing, privileging, and provider enrollment activities. • Build, lead, and mentor a high-performing credentialing team with appropriate staffing, training, accountability, and performance management. • Develop and implement departmental goals, SOPs, KPIs, and quality assurance measures. • Facilitate training, ongoing education, and change management as credentialing systems and requirements evolve. • Oversee verification of licensure, education, training, certifications, work history, malpractice coverage, and professional references. • Establish proactive workflows for managing all expirable items, including license, certification, and insurance renewals. • Ensure accurate management of provider files, credentialing data, and documentation within credentialing software platforms. • Direct the privileging process in collaboration with medical leadership, department chiefs, and compliance teams. • Provide credentialing support for committee meetings, audits, board reviews, and documentation needs. • Ensure compliance with all federal, state, and local regulatory bodies including CMS, The Joint Commission, NCQA, URAC, and commercial payer standards. • Maintain up-to-date knowledge of regulatory changes and lead revisions to policies, procedures, and workflows accordingly. • Conduct and oversee internal audits to ensure readiness for accreditation surveys and external reviews. • Oversee timely and accurate submission of enrollment applications with Medicare, Medicaid, and commercial payers. • Track and manage enrollments, revalidations, payer updates, and expirables to prevent reimbursement delays or claim denials. • Partner with Revenue Cycle and Managed Care to resolve enrollment-related claim issues and streamline payer setup workflows. • Manage external credentialing and verification vendors, ensuring high performance, compliance, service quality, and contractual adherence. • Evaluate vendor capabilities, negotiate service agreements, monitor KPIs, and drive accountability for accuracy and turnaround times. • Lead transitions, implementations, or optimization projects involving outsourced credentialing or enrollment partners. • Continuously evaluate and enhance credentialing workflows to reduce turnaround times, improve accuracy, and support scalability. • Lead implementation or optimization of credentialing software, automation tools, and data-management technologies. • Develop and oversee dashboard reporting for KPIs, productivity, turnaround time, expirables, enrollment status, and quality metrics. • Collaborate with IT, Managed Care, Compliance, and Operations on cross-functional systems and technology initiatives. • Serve as the primary organizational contact for providers, clinical leaders, health plans, and regulatory bodies regarding credentialing matters. • Promote a provider-centric experience through timely communication, streamlined processes, and exceptional service standards. • Collaborate with HR, Legal, Compliance, Managed Care, and Clinical Operations on onboarding and cross-functional initiatives. • Deliver clear, concise presentations to executive leadership, including reporting on credentialing performance, risks, and mitigation strategies. • Prepare and present executive-ready materials including slide decks, dashboards, and credentialing summaries for operational and leadership reviews. Skills • Bachelor’s degree in healthcare administration, business, or related field. • 7 or more years of credentialing experience in a healthcare organization, MSO, medical group, ASC, hospital, or health plan. • 3 or more years of leadership or management experience. • Strong working knowledge of CMS, Joint Commission, NCQA, URAC, and payer credentialing and enrollment requirements. • Proficiency with credentialing software systems, provider databases, and digital document management. • Master’s degree in healthcare administration, business administration, or related field. • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM). • Experience in multi-site or multi-state healthcare delivery organizations, or MSOs. • Experience implementing credentialing software or leading large-scale credentialing process redesign. Benefits • 401(k) • Health insurance • Opportunity for advancement Company Overview • American Family Care is a medical practice offering occupational health services. It was founded in 1982, and is headquartered in Birmingham, Alabama, USA, with a workforce of 1001-5000 employees. Its website is https://www.afcurgentcare.com.