Clarity RCM is the nation’s leading revenue cycle platform in dermatology, helping practices streamline operations, optimize billing, and navigate complex payer landscapes. Recognized on the Inc. 5000 list for two consecutive years as one of the nation’s fastest-growing private companies, Clarity is rapidly expanding and looking for top talent to join our team. We pay well – compensation for this role is commensurate with experience.

We are seeking a Credentialing & Contracting Lead to enhance our credentialing and payer contracting efforts, ensuring providers can seamlessly participate in insurance networks.

ROLE OVERVIEW:

As the Credentialing & Contracting Lead, you will be responsible for managing and improving the credentialing and payer enrollment process for our clients. You will play a key role in ensuring that providers are enrolled with the appropriate payers, maintaining compliance, and working to secure optimal contracts.

This role requires someone who is highly organized, tech-savvy, and detail-oriented, with strong customer service, project management, and leadership skills. The ideal candidate will not only execute and improve credentialing operations but also serve as a mentor and coach, guiding both direct reports and cross-functional colleagues on best practices in credentialing and contracting.

You should be comfortable building relationships with payers, troubleshooting credentialing-related issues, and proactively managing contracts across multiple states. The role offers an opportunity for growth within the organization, making it ideal for someone looking to take on increasing leadership responsibilities.

KEY RESPONSIBILITIES:

Credentialing & Payer Enrollment

• Manage end-to-end credentialing and re-credentialing processes for providers across multiple states.
• Submit and track payer enrollment applications, ensuring timely follow-up and resolution.
• Maintain accurate credentialing records, including CAQH, NPPES, and state Medicaid enrollments.
• Work closely with providers to gather and verify required documentation.

Payer Contracting & Negotiations

• Research payer participation status and communicate contract requirements to practices.
• Assist in obtaining, reviewing, and negotiating payer contracts.
• Identify opportunities for contract optimization and reimbursement improvements.
• Develop and maintain strong relationships with commercial and government payers, often requiring persistence in identifying the right contacts.

Coaching & Mentorship

• Provide training, coaching, and mentorship to team members and colleagues, helping to build a strong credentialing knowledge base across the organization.
• Support both direct reports and cross-functional team members, sharing best practices and improving internal expertise.
• Foster a culture of continuous learning and professional development within the credentialing team.
• Act as a resource and advisor for other departments that intersect with credentialing and contracting, such as billing and revenue cycle management.

Customer Service & Provider Support

• Serve as the primary point of contact for providers and clients regarding credentialing and contracting inquiries.
• Provide clear and proactive updates on credentialing progress.
• Educate providers and practice staff on network participation requirements.

Project Management & Process Improvement

• Develop and document credentialing workflows to improve efficiency.
• Leverage technology to streamline credentialing, contract management, and payer communications.
• Identify and implement tools to automate and enhance tracking of credentialing applications.
• Support special projects related to credentialing-related claim denials and payer escalations.

QUALIFICATIONS & EXPERIENCE:

• Significant experience in provider credentialing, payer contracting, or network enrollment
• Experience working with private payers (BCBS, Aetna, Cigna, UHC) and government payers (Medicare, Medicaid, Tricare).
• Strong understanding of credentialing databases, CAQH, NPPES, PECOS, and provider enrollment systems.
• Tech-savvy with a willingness to embrace new tools (experience with credentialing software a plus).
• Excellent project management skills with the ability to track and follow up on multiple applications.
• Strong customer service and communication skills, with the ability to clearly explain payer processes to providers.
• Problem-solver who enjoys troubleshooting and finding the right contacts at payers to resolve issues.
• Ability to coach, mentor, and train others, whether in a leadership role or as a subject-matter expert.
• Experience with multi-state credentialing and contracting preferred.
• Prior experience in medical billing, revenue cycle, or healthcare operations is a plus.

WHY JOIN CLARITY RCM?

• Fast-growing, industry-leading company in dermatology revenue cycle management.
• Opportunity for growth within a forward-thinking organization.
• Remote flexibility with a dynamic and collaborative team.
• Cutting-edge technology to support and automate processes.
• Make an impact by improving the credentialing experience for providers and helping practices succeed.

HOW TO APPLY:

• To be considered for this position, please submit your application through our career website using the Apply to Position, Use My Indeed Resume, or Apply Using LinkedIn buttons.
• Resumes sent via email will NOT be reviewed.
• Do NOT contact Clarity RCM directly about this job posting.