Manager, Provider Data Management – Credentialing

This is a fully remote position, open to applicants in Arizona, +5 more states.

📋 Description

• Manage the operations of credentialing and provider data management functions across multiple business units.

• Supervise the credentialing and re-credentialing processes for physicians, mid-level practitioners, and organizational providers.

• Oversee provider setup procedures for claims payment, member assignment, and directory display.

• Ensure adherence to NCQA and DHHS credentialing requirements.

• Participate in initiatives related to the plan's NCQA accreditation.

• Collaborate with health plans and departments on network expansion, large claims, contract amendment projects, and other related initiatives.

• Identify opportunities for process improvements to reduce costs, enhance quality, and increase efficiency.

• Review and revise departmental policies and procedures to ensure compliance with NCQA, CMS, and other regulatory agencies.

• Monitor compliance with HCFA requirements through Medicaid and Medicare sanctioning reports.

• Facilitate activities of the Credentialing Committee.

• Serve on Quality Improvement Committees as needed.

⛳️ Requirements

• Must possess authorization to work in the U.S. without the need for employment-based visa sponsorship, both now and in the future.

• Bachelor’s degree in a related field or equivalent experience is required.

• A minimum of 5 years of combined experience in management, provider data management, credentialing, or healthcare operations.

• Experience in a managed care or insurance environment is preferred.

• Previous experience in a leadership role within a functional area, managing cross-functional teams on large-scale projects, or supervisory experience is necessary.

• Supervisory experience that includes hiring, training, delegating tasks, and managing employee performance.

• Knowledge of NCQA, DHHS, CMS, and other regulatory standards is essential.

• Experience in the credentialing and re-credentialing of physicians, mid-level practitioners, and organizational providers.

• Familiarity with provider setup processes for claims payment, member assignment, and directory display.

• Experience in monitoring Medicaid and Medicare sanctioning reports and ensuring compliance with HCFA requirements.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the overall compensation package.

• We are an equal opportunity employer committed to diversity.