Director of Contracts and Credentialing

Reporting

This position reports to VP of Operations.

Our Mission

Closing the care gap through virtual care delivery and bringing health equity to underserved communities.

Who is Certintell

Founded in 2014, Certintell is a Care Management company that offers programs to Medicare, Medicaid, and Dual-eligible patients in partnership with medical clinics, pharmacies and insurance providers. Certintell acts as a virtual care clinic by providing programs that improve access to care, reduce the cost burden of chronically ill patients, increases revenues to the Health Center and can improve overall Value-based Payments (VBP) and other relevant outcome-driven ratings (e.g. HEDIS).

CORE VALUES

• INNOVATION: Excel Innovation and Stay Forward Thinking
• COMPASSION: Live and Breath Compassion
• INTEGRITY: Integrity at the Root of Everything
• EXCELLENCE: Bring Excellence Everyday

Job Description

The Director of Contracts and Credentialing will play a pivotal role in ensuring that our organization remains in good standing as a licensed Telehealth service provider across 48 states. This role will oversee the contracting and credentialing processes with Medicare, Medicaid, and Managed Care Organizations (MCOs) in individual states. The Director will develop and implement strategies to ensure compliance, maintain licensure, and support the organization’s growth in a fast-paced, healthcare-focused environment.

Contract Management

• Develop, negotiate, and manage contracts with Medicare, Medicaid, and MCOs in all 50 states.
• Monitor contract renewals, amendments, and compliance deadlines.
• Maintain a centralized database of all contracts, agreements, and state-specific regulations.
• Collaborate with legal and compliance teams to ensure alignment with state and federal healthcare laws.
• Evaluate and mitigate risks related to contract terms and conditions.

Credentialing

• Oversee the credentialing process for individual providers and the organization with Medicare, Medicaid, and MCOs.
• Develop and maintain systems to ensure timely submission of applications and renewals.
• Monitor state-specific credentialing requirements and maintain up-to-date knowledge of payer policies.
• Ensure that all provider and organizational licenses are current and in good standing.
• Partner with internal teams to facilitate onboarding of new providers and manage ongoing compliance requirements.

Compliance and Reporting

• Ensure compliance with state and federal healthcare regulations, including Medicare and Medicaid guidelines.
• Develop and implement policies and procedures to maintain regulatory compliance.
• Prepare regular reports on contract status, credentialing timelines, and compliance metrics for leadership.
• Serve as the primary point of contact for audits related to contracts and credentialing.

Leadership and Collaboration

• Lead and mentor a team of credentialing and contracting specialists.
• Collaborate with the VP of Operations, Clinical, Legal, and Finance teams to align strategies and objectives.
• Drive continuous process improvements to enhance efficiency and accuracy in contract and credentialing workflows.
• Represent the organization in discussions with payers and regulatory agencies.

Qualifications

Education and Experience

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field (Master’s preferred).
• Minimum of 7 years of experience in healthcare contracting, credentialing, or a related field, with at least 3 years in a leadership role.
• In-depth knowledge of Medicare, Medicaid, and MCO regulations and requirements.
• Experience working with multi-state licensure and credentialing processes.
• Familiarity with Telehealth operations is strongly preferred.

Skills and Competencies

• Strong understanding of healthcare regulatory requirements at the state and federal levels.
• Excellent negotiation, communication, and interpersonal skills.
• Proficiency in credentialing software and contract management systems.
• Detail-oriented with exceptional organizational and time-management skills.
• Ability to analyze complex regulations and implement practical solutions.
• Strong leadership and team management abilities.

Diversity
Certintell EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status. Thorough background checks are required as a condition of employment.

Job Type: Full-time

Pay: $60,000.00 - $75,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off

Schedule:

• Monday to Friday

Work Location: Hybrid remote in Windsor Heights, IA 50324

Salary : $60,000 - $75,000