Senior Credentialing Adminsitrator

Cortica•San Diego, CA

10h

About The Position

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.

Requirements

A bachelor's degree or equivalent of 3+ years’ experience in provider credentialing, enrollment and provider licensing management.
3+ years’ experience handling health plan provider information and data requirements.
3+ years of experience operating Credentialing software and databases.
Demonstrated critical thinking skills and are a detail-oriented problem solver.

Responsibilities

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.