Senior Credentialing Administrator
Cortica is looking for a Senior Credentialing Administrator to join our growing multi-disciplinary team!
The Senior Credentialing Administrator oversees end-to-end credentialing, enrollment, and licensing processes, ensuring compliance, efficiency, and timely execution. This role drives process improvements, tracks key metrics, and provides insights to leadership while resolving issues and maintaining accurate provider data. The Senior Credentialing Administrator manages relationships with providers, vendors, and payers, supports delegated credentialing, and leads audits to ensure regulatory compliance and implement corrective actions.
Cortica is a rapidly growing healthcare company pioneering the most effective treatment methods for children with neurodevelopmental differences. Our mission is to design and deliver life-changing care – one child, one family, one community at a time. Ultimately, we envision a world that cultivates the full potential of every child. At Cortica, every team member is instrumental in helping us achieve our mission!
Our culture and values guide how we work and treat one another. Cortica celebrates diversity and fosters an inclusive environment, seeking ideas and opinions from everyone on the team. We safeguard equal rights and respect for all individuals, regardless of race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry, veteran status or other applicable, legally protected characteristics. All Cortica employment decisions are made based on an individual’s qualifications and ability to successfully perform the job responsibilities.
What will you do?
• Own end-to-end credentialing, enrollment, and licensing application processes ensuring compliance, scalability, and timely execution.
• Lead continuous improvement practices to optimize efficiency, accuracy, and provider experience.
• Define, maintain, and track KPIs and key metrics. Provide actionable insights and recommendations to stakeholders and leadership.
• Troubleshoot credentialing, enrollment, and licensing issues and research and resolve questions from vendors, providers, and payers.
• Maintain accurate, organized, and accessible provider-specific and facility-level data required for credentialing, enrollment, and licensing.
• Maintain and grow relationships with providers, vendors, and internal stakeholders. This may include working with payers to receive and maintain approval for delegated credentialing.
• Maintain and update workflows and training materials.
• Lead internal and external audits, including delegated credentialing payer audits.
• Ensure compliance with regulatory and payer requirements; proactively identify and mitigate risks.
• Report audit findings and drive corrective actions. Report adverse findings to regulatory agencies.
• Maintain a strict level of confidentiality regarding provider information and organizational matters.
• Responsible to follow-up on verifications and credentialing data collection to support efficient, high-volume processing of provider applications in accordance with credentialing standards, established procedural guidelines, and required timelines.
• Prepare documents for Credentialing Committee review; establish electronic daily file review process and lead all Credentialing Committee meetings and record minutes.
• Perform annual internal credentialing audit to ensure adherence to policies and procedures as well as payer delegation requirements.
We’d love to hear from you if:
• You have a bachelor's degree or equivalent of 3+ years’ experience in provider credentialing, enrollment and provider licensing management.
• You have 3+ years’ experience handling health plan provider information and data requirements.
• You bring 3+ years of experience operating Credentialing software and databases.
• You have demonstrated critical thinking skills and are a detail-oriented problem solver.
Your Compensation & Benefits:
Cortica cares deeply about the well-being of each member of our team, and we have created a passionate, caring, and growth-minded culture that helps teammates thrive! As a Cortica teammate, we’ll support your well-being through medical, dental, and vision insurance, a 401(k) plan with company matching and rapid vesting, paid holidays and wellness days, life insurance, disability insurance options, tuition reimbursements for professional development and continuing education, and referral bonuses. We value you and the experience you bring to your role, and are proud to provide you with a compensation and benefits package designed to enhance all aspects of your life.
The base pay range for this opening is $72,711.11 to $90,888.89. According to your skill level, relevant experience, education level, and location, you will receive compensation that fits appropriately within the range.
EOE. This posting is not meant to be an exhaustive list of the role and its duties. Please review the job description in the following link: Job Description
About Cortica:
Cortica is a leading provider of advanced neurological therapies for children with autism and other developmental differences. We offer in-home, in-clinic, and telehealth services that empower families to achieve long-lasting, transformative results.
The Senior Credentialing Administrator oversees end-to-end credentialing, enrollment, and licensing processes, ensuring compliance, efficiency, and timely execution. This role drives process improvements, tracks key metrics, and provides insights to leadership while resolving issues and maintaining accurate provider data. The Senior Credentialing Administrator manages relationships with providers, vendors, and payers, supports delegated credentialing, and leads audits to ensure regulatory compliance and implement corrective actions.
Cortica is a rapidly growing healthcare company pioneering the most effective treatment methods for children with neurodevelopmental differences. Our mission is to design and deliver life-changing care – one child, one family, one community at a time. Ultimately, we envision a world that cultivates the full potential of every child. At Cortica, every team member is instrumental in helping us achieve our mission!
Our culture and values guide how we work and treat one another. Cortica celebrates diversity and fosters an inclusive environment, seeking ideas and opinions from everyone on the team. We safeguard equal rights and respect for all individuals, regardless of race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry, veteran status or other applicable, legally protected characteristics. All Cortica employment decisions are made based on an individual’s qualifications and ability to successfully perform the job responsibilities.
What will you do?
• Own end-to-end credentialing, enrollment, and licensing application processes ensuring compliance, scalability, and timely execution.
• Lead continuous improvement practices to optimize efficiency, accuracy, and provider experience.
• Define, maintain, and track KPIs and key metrics. Provide actionable insights and recommendations to stakeholders and leadership.
• Troubleshoot credentialing, enrollment, and licensing issues and research and resolve questions from vendors, providers, and payers.
• Maintain accurate, organized, and accessible provider-specific and facility-level data required for credentialing, enrollment, and licensing.
• Maintain and grow relationships with providers, vendors, and internal stakeholders. This may include working with payers to receive and maintain approval for delegated credentialing.
• Maintain and update workflows and training materials.
• Lead internal and external audits, including delegated credentialing payer audits.
• Ensure compliance with regulatory and payer requirements; proactively identify and mitigate risks.
• Report audit findings and drive corrective actions. Report adverse findings to regulatory agencies.
• Maintain a strict level of confidentiality regarding provider information and organizational matters.
• Responsible to follow-up on verifications and credentialing data collection to support efficient, high-volume processing of provider applications in accordance with credentialing standards, established procedural guidelines, and required timelines.
• Prepare documents for Credentialing Committee review; establish electronic daily file review process and lead all Credentialing Committee meetings and record minutes.
• Perform annual internal credentialing audit to ensure adherence to policies and procedures as well as payer delegation requirements.
We’d love to hear from you if:
• You have a bachelor's degree or equivalent of 3+ years’ experience in provider credentialing, enrollment and provider licensing management.
• You have 3+ years’ experience handling health plan provider information and data requirements.
• You bring 3+ years of experience operating Credentialing software and databases.
• You have demonstrated critical thinking skills and are a detail-oriented problem solver.
Your Compensation & Benefits:
Cortica cares deeply about the well-being of each member of our team, and we have created a passionate, caring, and growth-minded culture that helps teammates thrive! As a Cortica teammate, we’ll support your well-being through medical, dental, and vision insurance, a 401(k) plan with company matching and rapid vesting, paid holidays and wellness days, life insurance, disability insurance options, tuition reimbursements for professional development and continuing education, and referral bonuses. We value you and the experience you bring to your role, and are proud to provide you with a compensation and benefits package designed to enhance all aspects of your life.
The base pay range for this opening is $72,711.11 to $90,888.89. According to your skill level, relevant experience, education level, and location, you will receive compensation that fits appropriately within the range.
EOE. This posting is not meant to be an exhaustive list of the role and its duties. Please review the job description in the following link: Job Description
About Cortica:
Cortica is a leading provider of advanced neurological therapies for children with autism and other developmental differences. We offer in-home, in-clinic, and telehealth services that empower families to achieve long-lasting, transformative results.