Vice President of Credentialing & Regulatory Compliance

Credentialing Regulatory Compliance

Company Overview:

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team

We are seeking an exceptional VP of Credentialing to lead our credentialing, compliance, and provider onboarding efforts with absolute precision and accountability. This is a high-stakes leadership role that ensures our providers meet all regulatory, accreditation, and contractual requirements—both internally and with external partners.

Shift Structure:

• Monday-Friday 8:30am-6pm EST
• Remote position

Employment Type:

• This is a full time, exempt position.

Responsibilities:

• Oversee the entire credentialing function, ensuring all provider enrollments, renewals, and state expansions are completed accurately and on time.
• Ensure compliance with all regulatory and accreditation requirements for internal providers and external partners.
• Develop and enforce credentialing policies and procedures aligned with federal, state, and payer regulations.
• Lead and manage the onboarding credentialing process for new providers, ensuring they are fully credentialed before their start date.
• Manage ongoing provider credentialing, including COI (Certificates of Insurance), DEA registration, license renewals, recredentialing.
• Oversee credentialing for new state launches to ensure smooth expansion into new markets.
• Continuously improve credentialing systems and processes, leveraging automation and technology to enhance efficiency.
• Serve as the primary liaison between Human Resources, Legal, Compliance, and Clinical teams to align credentialing efforts.
• Maintain strong relationships with external payors and credentialing partners to ensure compliance with all requirements.

Requirements Qualifications

• Bachelor’s or Master’s degree in Human Resources, Business Administration, or a related field.
• Minimum of 10 years of credentialing experience, including leadership in a healthcare setting.
• Strong expertise in compliance, provider enrollment, and onboarding processes.
• Ability to create and enforce credentialing policies while ensuring alignment across departments.
• Strong leadership, communication, and problem-solving skills.
• High attention to detail and the ability to manage multiple priorities effectively.

Compensation and Benefits:

• Up to 160,000/year DOE
• Health Insurance
• 401k with employer match