QualDerm Partners, LLC partners with physicians and staff to provide highest quality clinical care to patients. We provide the full spectrum of dermatology, skin cancer care, cosmetics, plastic surgery in 17 states and across 158 practice locations. We seek to hire best in class talent and commit to provide a positive combination of environment, technology, teamwork and personal reward opportunities to earn your confidence that we are your best place to work.
PURPOSE:
Reporting to the Senior Director, Credentialing and Revenue Cycle, the Manager, Provider Credentialing and Payer Enrollment is responsible for overseeing all aspects of the credentialing, re-credentialing, payer enrollment, and privileging processes for all providers, groups, and locations across the organization.
The Manager will develop strong relationships with regional and market operational leaders to ensure proactive communication on credentialing and recredentialing requirements, while ensuring credentialing experiences no unnecessary delays prior to services being rendered under contracted and enrolled health plans.
The Manager will be responsible for implementing processes and capturing data for each provider in Qualderm’s internal credentialing database and online systems for utilization across multiple stakeholder groups.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Under direction of Sr. Director, oversee all aspects of provider credentialing and payer enrollment on a national level across the organization.
- Assist with oversight of credentialing/payer enrollment activities for new providers, group entities, location additions/de novo locations and new payer contracts
- Ensure CAQH, Verity and any other credentialing/payer databases are accurate and updated in a timely manner
- Ensure that new provider checklists, credentialing tracker, Fresh Service tickets are all updated and reflect accurate information
- Serve as Subject Matter Expert (SME) for payer-related matters and review payer or credentialing issues related to growth of the business in coordination with Sr. Director.
- Work collaboratively with Payer Contracting, Revenue Cycle Management, Human Resources, Integration, Finance, Compliance, and Operational areas to ensure accurate information sharing, appropriate communication of any delays or other issues, and complete reporting of performance and pertinent information for decision making.
- Manage the team of credentialing/payer enrollment resources to ensure consistency in hiring, training, onboarding, and skill development. Maintain adequate resources to support the needs of the market.
- Adhere to applicable health plan requirements related to provider certification and credentialing. Manage and monitor department activities to ensure compliance with all policies, procedures, and regulations.
- Under direction of the Senior Director, oversee teams responsible for special projects requiring knowledge of delegated and non-delegated health plan requirements.
- Manage processes that maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
- Maintain confidentiality of organizational and provider information.
- Assist in managing the flow of information between payers, contracted MSO, CIN, PHO, IPA, ACO, and other networks across the organization.
- Coordinate and prepare management reports as needed.
- Create and manage continual process and quality improvement efforts related to payer enrollment, data entry, credentialing committees, and all aspects related to credentialing and enrollment.
- Design and review credentialing statistics that will drive improvement and hold people accountable for results, in coordination with the Senior Director.
- In conjunction with the Senior Director, oversee work to ensure the entire Credentialing and Enrollment team is fully trained and able to work independently to the level of their role.
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 major payers (Aetna, BCBS, Cigna, Humana, Medicare, Medicaid, UHC) required
- Experience enrolling payers under multiple Tax IDs preferred
- Demonstrated skills in analysis, problem solving, and resolution.
- Ability to communicate appropriately and effectively with practitioners and providers, including sensitive and confidential information.
- High level of attention to detail with exceptional organizational skills.
- Ability to present complex information in a concise and clear manner to allow for appropriate operational leadership input and education.
- Maintain compliance with all NCQA, CMS, and applicable state laws and regulations as they pertain to credentialing/payer enrollment.
- Ability to solve problems, explore all options, and use available resources to find new and effective solutions.
- Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements.
- Must be able to function independently and possess demonstrated flexibility in managing multiple projects.
- Assist with other duties as assigned
Benefits
Benefits of joining Qualderm Partners:
- Competitive Pay – Attractive compensation to reward your hard work
- Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans to keep you covered
- 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 enjoy 6 paid holidays and 2 floating holidays each year
- Company-Paid Life Insurance – Peace of mind with basic life coverage, with the option for additional plans
- Disability Protection – Short-term and long-term disability coverage to protect you in unexpected circumstances
- Additional Wellness Plans – Accident, critical illness, and identity theft protection plans for extra security
- Employee Assistance Program (EAP) – Access confidential support for personal or work-related challenges
- Exclusive Employee Discounts – Save on products and services with special discounts just for you
- Referral Bonus Program – Earn bonuses by referring qualified candidates to join the team
QualDerm Partners is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Applicants must be currently authorized to work in the United States in a full-time basis.
Compensation Range: $75,000 - 95,000 annually. Final offer will be based on a combination of skills, experience, location, and internal equity.
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