WE
Wedgewood Weddings & EventsWedding Venue General Manager
Wedding Venue General Manager overseeing hospitality operations at Wedgewood Weddings. Responsible for venue management, team leadership, and ensuring guest satisfaction.
About the role
- Collect, verify, and maintain documentation for the credentialing and recredentialing of healthcare providers.
- Conduct background checks and review professional references.
- Ensure timely and accurate completion of credentialing applications, including CAQH, state Medicaid programs, Medicare PECOS, hospital medical staff offices, and commercial payer portals.
- Maintain up-to-date knowledge of state, federal, and accreditation requirements (e.g., CMS, NCQA, Joint Commission).
- Ensure compliance with organizational policies and credentialing standards.
- Maintain and update provider credentialing databases and tracking tools.
- Generate reports and track the status of credentialing and privileging applications with hospitals and health plans.
- Serve as a point of contact for healthcare providers regarding credentialing requirements, timelines, and status updates.
- Collaborate with clinical, administrative, and onboarding teams to facilitate seamless provider integration.
- Identify opportunities to optimize workflow in credentialing processes.
- Participate in training and development activities related to credentialing best practices.
- Assist in the coordination, preparation, and submission of payer enrollment forms, contract documents, amendments, and rate updates.
- Maintain contract documentation, payer correspondence, fee schedules, effective dates, and payment terms in centralized repositories.
- Track contract status across all practices, including renewals, expirations, delegated agreements, and participation changes.
- Support analysis of payer contracts, fee schedules, and reimbursement terms to identify gaps, discrepancies, or risks.
- Prepare summaries, comparison sheets, or redlines to support leadership decision-making and negotiation strategy.
- Collaborate with payers to resolve contract setup issues, enrollment errors, rate loading discrepancies, or network status delays.
- Assist in gathering utilization, rate, and policy information needed for contracting initiatives.
- Monitor payer policy updates, reimbursement changes, and regulatory requirements relevant to contracting work.
- Support cross-functional teams including Revenue Cycle, Operations, and Finance to ensure contract terms are operationally executable.
- Participate in payer meetings, contract implementation reviews, or special projects as assigned.
Requirements
- Bachelor’s degree in healthcare administration, business, or a related field preferred.
- Minimum of 2 years of experience in credentialing, contracting, payer enrollment, or a related healthcare administrative field.
- Familiarity with medical terminology, healthcare regulations, and payer structures.
- Strong organizational skills and high attention to detail, with the ability to manage multiple priorities simultaneously.
- Excellent verbal and written communication abilities.
- Proficiency in credentialing software, payer portals, and Microsoft Office Suite (Excel proficiency strongly preferred).
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