Position Summary:
The Credentialing and Enrollment Manager will oversee the processing of applications and reapplications for medical staff and allied health professionals to ensure compliance with national accreditation standards and state and federal regulatory requirements.
Responsibilities:
Ensure provider staff is credentialed and enrolled with payers to ensure sufficient clinical coverage and minimal claims reimbursement denials
- Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs.
- Manage the primary source verification of education, training, board certification, work history, and licensure of healthcare providers.
- Maintain CMS NPPES reporting.
Oversee the work of the outsourced enrollment vendor to ensure high performance, measured via a short time to complete enrollment and positive provider/new hire experience
- Development and reporting of operational metrics
- Monitor and manage turnaround times for processing of credentials applications
- Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.
Support internal credentialing committee in evaluation of newly hired staff
- Facilitate the resolution of discrepancies or concerns regarding applicants’ credentials, working closely with medical staff leadership and healthcare providers.
- Maintain accurate and confidential credentialing databases and files, ensuring the security and integrity of sensitive provider information.
Effectively communicate accurate enrollment and credentialing status throughout the organization to support effective decision making
- Assist the accounts receivable department with credentialing related payor denials.
Coordinate with counsel and compliance on malpractice and related insurance coverage
Qualifications:
- Minimum of five (5) years of progressively responsible operational or consulting experience in provider credentialing and enrollment in an outpatient setting.
- Medallion system experience preferred.
- Knowledge and experience of the healthcare industry or medical financial operations.
- Possess ability to identify patterns and conduct root cause analysis.
- Maintain accurate and up-to-date provider credentialing information in the database.
- Experience with CAQH (Council for Affordable Quality Healthcare) database and application process.
- Strong attention to detail and organizational skills. Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments.
Job Type: Full-time
Pay: $80,000.00 - $110,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work Location: Remote