Manager, Provider Credentialing – Payer Enrollment

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise the provider credentialing, re-credentialing, payer enrollment, and privileging processes on a national scale throughout the organization.

• Manage credentialing and payer enrollment for new providers, group entities, newly established locations, and new payer contracts.

• Ensure accuracy and timeliness of CAQH, Verity, and other credentialing/payer databases.

• Maintain precise provider checklists, credentialing trackers, and Fresh Service tickets.

• Act as the subject matter expert regarding payer-related issues and credentialing concerns.

• Collaborate with teams in Payer Contracting, Revenue Cycle Management, Human Resources, Integration, Finance, Compliance, and Operations.

• Oversee the credentialing and payer enrollment resources, which includes hiring, training, onboarding, and skill enhancement.

• Monitor adherence to health plan requirements, policies, procedures, and regulations.

• Manage special projects related to both delegated and non-delegated health plan requirements.

• Ensure timely renewal of provider licenses and certifications while safeguarding confidential information.

• Direct the flow of information among payers, contracted MSO, CIN, PHO, IPA, ACO, and other networks.

• Coordinate and generate management reports.

• Lead initiatives aimed at process and quality improvements concerning payer enrollment, data entry, credentialing committees, and enrollment.

• Design and assess credentialing statistics to foster improvement and accountability.

• Ensure that the Credentialing and Enrollment team is thoroughly trained and capable of working autonomously.

⛳️ Requirements

• A minimum of five (5) to seven (7) years of experience in managed care credentialing and payer enrollment is required.

• Preference for candidates with national or multi-state credentialing leadership experience.

• Required experience with payer enrollment for Aetna, BCBS, Cigna, Humana, Medicare, Medicaid, and UHC.

• Preference given to those with experience enrolling payers under multiple Tax IDs.

• Proven analysis, problem-solving, and resolution skills.

• Strong ability to communicate effectively with practitioners and providers, including when handling sensitive and confidential information.

• Exceptional attention to detail and outstanding organizational abilities.

• Capability to present complex information clearly and concisely for operational leadership input and education.

• Knowledge of compliance requirements related to NCQA, CMS, and relevant state laws and regulations for credentialing and payer enrollment.

• Ability to solve problems, explore alternatives, and utilize available resources to identify effective solutions.

• Proficient in prioritizing tasks and meeting ongoing deadlines.

• Ability to operate independently while managing multiple projects in a flexible manner.

• Applicants must currently possess authorization to work in the United States on a full-time basis.

🏝️ Benefits

• Competitive Pay – Attractive compensation to reward your hard work.

• Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans.

• Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting.

• Paid Time Off (PTO) – Accrue PTO from day one, in addition to 6 paid holidays and 2 floating holidays each year.

• Company-Paid Life Insurance – Basic life coverage, with the option for additional plans.

• Short-term and long-term disability coverage.

• Accident, critical illness, and identity theft protection plans.

• Employee Assistance Program (EAP).

• Exclusive Employee Discounts.

• Referral Bonus Program.