Job Description

Qualifications: Education, Licensure and Certifications, Related Work Experience

· Associate’s degree or equivalent required. Bachelor's degree preferred

· Minimum 5 years of provider credentialing experience in outpatient or multi-specialty settings

· CPCS or CMSC highly desirable

Other specialized skills and knowledge necessary to perform this job. (e.g., basic accounting principles, computer skills and software, specific healthcare processes, interpersonal, communication, etc.

1.

Proficiency with credentialing software (MedTrainer, Modio, or similar)

3.

Credentialing regulations (CMS, NCQA, Joint Commission) and Payer enrollment, CAQH, PECOS, knowledge

2.

Strong analytical and organizational skills

4.

Ability to manage competing priorities and deadlines

Essential Job Duties/Responsibilities

1.

Oversee end-to-end credentialing and recredentialing for all outpatient providers

2.

Manage credentialing staff and external vendors; provide training and performance management

3.

Ensure compliance with CMS, NCQA, Joint Commission, and payer standards

4.

Maintain and optimize credentialing databases and tracking systems

5.

Oversee payer enrollment, monitor rosters, resolve discrepancies

6.

Audit credentialing files and processes; implement corrective actions

7.

Collaborate with Recruiting, HR, and Revenue Cycle for seamless provider onboarding

8.

Develop and maintain credentialing policies and procedures

9.

Monitor expiring documents and ensure timely renewals

10.

Other related duties as assigned.

Compliance Requirements

Adherence to Laws, Rules, Regulations, Standards, Guidelines, Policies and Procedures:

· Ensure compliance with all federal, state, and local laws, regulations, standards, guidelines, and Eventus WholeHealth policies and procedures pertaining to the job.

· Remain informed of any changes to federal, state, and local laws, regulations, standards,guidelines, and Eventus WholeHealth policies and procedures that impact the job and the company.

· Promptly report any non-compliant conduct and/or practices to Eventus WholeHealth’s Chief Compliance and Risk Officer.

Ethical Conduct:

· Ensure adherence to Eventus WholeHealth's Code of Ethics and Business Conduct.

· Perform the job duties with integrity and professionalism.

· Promptly report any unethical conduct and/or practices to Eventus WholeHealth’s Chief Compliance and Risk Officer.

Patient Privacy and Confidentiality:

· Strictly protect patient information in accordance with all federal and state privacy laws and Eventus WholeHealth policies and procedures.

· Promptly report any violations of federal and state privacy laws and Eventus WholeHealth

· policies and procedures to Eventus WholeHealth’s Chief Compliance and Risk Officer.

Documentation and Record Keeping:

· Maintain accurate and complete documentation when performing the job duties.

· Ensure that all Eventus WholeHealth information, data, documentation, and records are always safeguarded and maintained confidentially.

Training and Education:

· Participate in all assigned training.

· Complete all assigned training by the deadline for completion.

Risk Management and Incident Reporting:

· Engage in regular risk assessments to identify potential risks and work proactively with a supervisor and Eventus WholeHealth’s Chief Compliance and Risk Officer to mitigate any identified risks.

· Promptly report any incidents (as defined in the “Incident Report Policy”) to the Chief Compliance and Risk Officer.