Vice President - Credentialing & Regulatory Compliance

February 20

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Theoria Medical

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Theoria Medical is a leader in tech-enabled, value-based primary care, revolutionizing healthcare for senior living communities nationwide. The company employs a fully integrated model of care, combining primary care services with the latest technological advancements to offer a holistic and impactful healthcare experience for seniors. Their innovative offerings include remote patient monitoring, medical directorship, on-site medical staff, telemedicine, and workflow optimizations, all anchored by pioneering technologies like ChartEasy, ChatEasy, and ProphEasy. Theoria Medical is committed to enhancing patient outcomes through digital innovation and serves patients in skilled nursing, assisted living, and independent living settings across the United States.

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

📡 Telecommunications

📋 Description

• Oversee the entire credentialing function, ensuring all provider enrollments, renewals, and state expansions are completed accurately and on time. • Ensure compliance with all regulatory and accreditation requirements for internal providers and external partners. • Develop and enforce credentialing policies and procedures aligned with federal, state, and payer regulations. • Lead and manage the onboarding credentialing process for new providers, ensuring they are fully credentialed before their start date. • Manage ongoing provider credentialing, including COI (Certificates of Insurance), DEA registration, license renewals, recredentialing. • Oversee credentialing for new state launches to ensure smooth expansion into new markets. • Continuously improve credentialing systems and processes, leveraging automation and technology to enhance efficiency. • Serve as the primary liaison between Human Resources, Legal, Compliance, and Clinical teams to align credentialing efforts. • Maintain strong relationships with external payors and credentialing partners to ensure compliance with all requirements.

🎯 Requirements

• Bachelor’s or Master’s degree in Human Resources, Business Administration, or a related field. • Minimum of 10 years of credentialing experience, including leadership in a healthcare setting. • Strong expertise in compliance, provider enrollment, and onboarding processes. • Ability to create and enforce credentialing policies while ensuring alignment across departments. • Strong leadership, communication, and problem-solving skills. • High attention to detail and the ability to manage multiple priorities effectively.

🏖️ Benefits

• Health Insurance • 401k with employer match