Job Description:
• Oversee provider credentialing, re-credentialing, payer enrollment, and privileging processes nationally across the organization
• Oversee credentialing and payer enrollment for new providers, group entities, new and de novo locations, and new payer contracts
• Ensure CAQH, Verity, and other credentialing/payer databases are accurate and timely
• Maintain accurate provider checklists, credentialing trackers, and Fresh Service tickets
• Serve as subject matter expert for payer-related matters and credentialing issues
• Collaborate with Payer Contracting, Revenue Cycle Management, Human Resources, Integration, Finance, Compliance, and Operations
• Manage credentialing and payer enrollment resources, including hiring, training, onboarding, and skill development
• Monitor compliance with health plan requirements, policies, procedures, and regulations
• Oversee special projects involving delegated and non-delegated health plan requirements
• Ensure timely renewal of provider licenses and certifications and maintain confidential information
• Manage information flow among payers, contracted MSO, CIN, PHO, IPA, ACO, and other networks
• Coordinate and prepare management reports
• Lead process and quality improvement efforts related to payer enrollment, data entry, credentialing committees, and enrollment
• Design and review credentialing statistics to drive improvement and accountability
• Ensure the Credentialing and Enrollment team is fully trained and able to work independently
Requirements:
• Five (5) to seven (7) years’ experience in managed care credentialing and payer enrollment required
• National or multi-state credentialing leadership experience preferred
• Experience with payer enrollment for Aetna, BCBS, Cigna, Humana, Medicare, Medicaid, and UHC required
• Experience enrolling payers under multiple Tax IDs preferred
• Demonstrated analysis, problem-solving, and resolution skills
• Ability to communicate effectively with practitioners and providers, including sensitive and confidential information
• High attention to detail and exceptional organizational skills
• Ability to present complex information concisely and clearly for operational leadership input and education
• Compliance knowledge relating to NCQA, CMS, and applicable state laws and regulations for credentialing and payer enrollment
• Ability to solve problems, explore options, and use available resources to find effective solutions
• Ability to prioritize and meet ongoing deadlines
• Ability to function independently and manage multiple projects flexibly
• Applicants must be currently authorized 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, plus 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