Job Information
Monte Nido Payor Credentialing Manager in Miami, Florida
We save lives while providing the opportunity for people to realize their healthy selves.
Payor Credentialing Manager
Monte Nido
Remote
For more than 25 years, Monte Nido has delivered proven treatment for eating disorders . Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our treatment setting is intimate with a high staff-to-client ratio, and an emphasis on individual therapy and highly individualized treatment.
Monte Nido is seeking a Payor Credentialing Manager to oversee and manage the credentialing and re-credentialing processes for our providers across all programs. This role ensures compliance with regulatory and payor requirements while streamlining provider enrollment and credentialing operations. The Payor Credentialing Manager reports to the Senior Director of Payor Contracting and collaborates closely with internal stakeholders to maintain provider network participation and optimize reimbursement.
Total Rewards:
Discover a rewarding career with us and enjoy an array of comprehensive benefits! We prioritize your success and well-being, providing:
Competitive compensation
Medical, dental, and vision insurance coverage (Benefits At a Glance (https://montenidoaffiliates.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=2025&hashed=-1683222091) )
Retirement
Company-paid life insurance, AD&D, and short-term disability
Employee Assistance Program (EAP)
Flexible Spending Account (FSA)
Health Savings Account (HSA)
Paid time off
Professional development
And many more!
We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Responsibilities Include:
Lead and manage the credentialing and re-credentialing processes for all Monte Nido providers, ensuring timely and accurate completion of applications.
Maintain up-to-date records in credentialing databases and systems, ensuring compliance with payor and regulatory requirements.
Work closely with the Senior Director of Payor Contracting to support contracting efforts by ensuring providers meet credentialing standards.
Establish and maintain relationships with insurance companies, managed care organizations, and other payors to facilitate efficient credentialing processes.
Monitor and track provider credentialing and enrollment status, proactively identifying and addressing potential issues.
Serve as the primary point of contact for payor credentialing inquiries and escalations.
Implement best practices and process improvements to enhance efficiency and reduce turnaround time for credentialing and enrollment.
Ensure compliance with all applicable laws, regulations, and accreditation standards related to provider credentialing and enrollment.
Train and support internal teams on credentialing procedures and requirements as needed.
Generate reports and analytics related to credentialing and payor enrollment to support leadership decision-making.
Qualifications:
Bachelor’s degree in healthcare administration, business, or a related field (or equivalent experience).
Minimum of 3-5 years of experience in provider credentialing and payor enrollment, preferably in a behavioral health or healthcare setting.
Strong understanding of payor credentialing requirements, NCQA, CAQH, and other industry standards.
Experience working with commercial and government payors, including Medicare and Medicaid.
Excellent organizational, problem-solving, and communication skills.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Proficiency in credentialing software and Microsoft Office Suite.
Strong attention to detail and ability to work both independently and collaboratively.
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